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Experience with physician assistants in a Canadian arthroplasty program.

PubMed

Bohm, Eric R; Dunbar, Michael; Pitman, David; Rhule, Chris; Araneta, Jose

2010-04-01

Recent increases in orthopedic surgical services in Canada have added further demand to an already stretched orthopedic workforce. Various initiatives have been undertaken across Canada to meet this demand. One successful model has been the use of physician assistants (PAs) within the Winnipeg Regional Health Authority (WRHA). This study documents the effect of PAs working in an arthroplasty practice from the perspective of patients and health care providers. We also describe the costs, time savings for surgeons and the effects on surgical throughput and waiting times. We calculated time savings by the use of a daily diary kept by the PAs. Surgeons', residents', nurses' and patients' opinions about PAs were recorded by use of a self administered questionnaire. We calculated costs using forgone general practitioner (GP) surgical assist fees and salary costs for PAs. We obtained information about surgical throughput and wait times from the WRHA waitlist database. In this study, PAs "saved" their supervising physician about 204 hours per year; this time can be used for other clinical, administrative or research duties. Physician assistants are regarded as important members of the health care team by surgeons, nurses, orthopedic residents and patients. When we compared the billing costs with those that would have been generated by the use of GP surgical assists, PAs were essentially cost neutral. Furthermore, they potentially freed GPs from the operating room to spend more time delivering primary care. We found that use of the double operating room model facilitated by PAs increased the surgical throughput of primary hip and knee replacements by 42%, and median wait times decreased from 44 weeks to 30 weeks compared with the preceding year. Physician assistants integrate well into the care team and can increase surgical volumes to reduce wait times in a cost-effective manner.

Implementing Six Sigma in The Netherlands.

PubMed

van den Heuvel, Jaap; Does, Ronald J M M; Bogers, Ad J J C; Berg, Marc

2006-07-01

Six Sigma, a process-focused strategy and methodology for business improvement, can be used to improve care processes, eliminate waste, reduce costs, and enhance patient satisfaction. Six Sigma was introduced in 2001 at the 384-bed Red Cross Hospital (Beverwijk). During the Green Belt training, every participant was required to participate in at least one Six Sigma project. The hospital's total savings in 2004 amounted to 1.4 million dollars, for an average savings of 67,000 dollars for each of the completed 21 projects. In one project, the team designed a new admission process for the operating rooms, resulting in an average starting time nine minutes earlier. This relatively minor improvement made it possible to operate on an additional 400 patients a year and to achieve a net savings of >273,000 dollars. A second project reduced the number of patients receiving intravenous (IV) antibiotics by switching to oral administration, yielding annual savings, based on medication costs alone, of >75,000 dollars. A third project reduced the length of stay in the delivery room from 11.9 to 3.4 hours, yielding an annual savings of 68,000 dollars. The "Ultimate Cure?": Six Sigma, which entails involvement of health care workers; use of improvement tools (from industry); creation of trained project teams to tackle complex, often cross-departmental processes; data analyses; and investment in quality improvement may prove the "ultimate cure" to the current cost, quality, and safety issues that challenge health care.

Can efficient supply management in the operating room save millions?

PubMed

Park, Kyung W; Dickerson, Cheryl

2009-04-01

Supply expenses occupy an ever-increasing portion of the expense budget in today's increasingly technologically complex operating rooms. Yet, little has been studied and published in the anesthesia literature. This review attempts to bring the topic of supply management to anesthesiologists, who play a significant role in operating room management. Little investigative work has been performed on supply management. Anecdotal reports suggest the benefits of a perpetual inventory system over a periodic inventory system. A perpetual inventory system uses utilization data to update inventory on hand continually and this information is linked to purchasing and restocking, whereas a periodic inventory system counts inventory at some regular intervals (such as annually) and uses average utilization to set par levels. On the basis of application of operational management concepts, ways of taking advantage of a perpetual inventory system to achieve savings in supply expenses are outlined. These include linking the operating room scheduling and supply order system, distributor-driven just-in-time delivery of case carts, continual updating of preference lists based on utilization patterns, increasing inventory turnovers, standardizing surgical practices, and vendor consignment of high unit-cost items such as implants. In addition, Lean principles of visual management and elimination of eight wastes may be applicable to supply management.

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

PubMed

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

2017-03-01

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

A new perspective on life-saving procedures in a battlefield setting: Emergency cricothyroidotomy, needle thoracostomy, and chest tube thoracostomy with night vision goggles.

PubMed

Bilge, Sedat; Aydın, Attila; Bilge, Meltem; Aydın, Cemile; Çevik, Erdem; Eryılmaz, Mehmet

2017-11-01

In the patients with multiple and serious trauma, early applications of life-saving procedures are related to improved survival. We tried to experimentally determine the feasibility of life-saving interventions that are performed with the aid of night vision goggles (NVG) in nighttime combat scenario. Chest tube thoracostomy (CTT), emergency cricothyroidotomy (EC), and needle thoracostomy (NT) interventions were performed by 10 combatant medical staff. The success and duration of interventions were explored in the study. Procedures were performed on the formerly prepared manikins/models in a bright room and in a dark room with the aid of NVG. Operators graded the ease of interventions. All interventions were found successful. Operators stated that both CTT and EC interventions were more difficult in dark than in daytime (p<0.05). No significant difference was observed in the difficulty in the NT interventions. No significant difference was observed in terms of completion times of interventions between in daytime and in dark scenario. The operators who use NVGs have to be aware of that they can perform their tactic and medical activities without taking off the NVGs and without the requirement of an extra light source.

76 FR 31680 - General Reporting and Recordkeeping by Savings Associations and Savings and Loan Holding Companies

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-01

... comments at the Public Reading Room, 1700 G Street, NW., Washington, DC 20552 by appointment. To make an... collection relates to reports and records required by the following regulations: 12 CFR 552.11 (books and... the savings association), 12 CFR 584.1(f) (books and records of each savings and loan holding company...

76 FR 16477 - General Reporting and Recordkeeping by Savings Associations and Savings and Loan Holding Companies

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-23

..., interested persons may inspect comments at the Public Reading Room, 1700 G Street, NW., by appointment. To... collection relates to reports and records required by the following regulations: 12 CFR 552.11 (books and... the savings association), 12 CFR 584.1(f) (books and records of each savings and loan holding company...

Energy efficient room temperature synthesis of cardanol-based novolac resin using acoustic cavitation.

PubMed

Jadhav, Nilesh L; Sastry, Sai Krishna C; Pinjari, Dipak V

2018-04-01

The present study deals with synthesis of cardanol-cased novolac (CBN) resin by the condensation reaction between cardanol and formaldehyde using acoustic cavitation. It is a step-growth polymerization which occurs in the presence of an acid catalyst such as adipic acid, citric acid, oxalic acid, sulphuric acid and hydrochloric acid. CBN was also synthesised by a conventional method for the sake of comparison of techniques. The effect of molar ratio, effect of catalyst, effect of different catalyst and effect of power on the conversion to CBN has been studied. The synthesised CBN was characterized using the Fourier Transform Infra Red Spectroscopy (FTIR), Gel Permeation Chromatography (GPC), Nuclear Magnetic Resonance (NMR) Spectroscopy and Thermogravimetric Analysis (TGA). The reaction was monitored by the Acid value, free formaldehyde content and viscosity of the synthesised product. The reaction time required for the conventionally synthesised CBN was 5 h (300 min) with 120 °C as an operating temperature while sonochemically the time reduced to 30 min at room temperature. The amount of time and energy saved can be quantified. Ultrasound facilitated synthesis was found to be an energy efficient and time-saving method for the synthesis of novolac resin. Copyright © 2017 Elsevier B.V. All rights reserved.

Practical tips for managing LinkedIn and Facebook (on top of everything else).

PubMed

Meerschaert, Carol

2012-01-01

Time-saving steps and strategies to help you make room for social media in your crowded day. I bet you've never thought to yourself, "I'd like more work to do". So how can you possibly accomplish everything and manage your association's LinkedIn group and Facebook page as well?

22. SOUTHWEST CORNER OF BANKING ROOM, FROM EAST, SHOWING CLOCK ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

22. SOUTHWEST CORNER OF BANKING ROOM, FROM EAST, SHOWING CLOCK ON SOUTH WALL AND TWO MEZZANINES BEYOND COLUMNS - Philadelphia Saving Fund Society, Twelfth & Market Streets, Philadelphia, Philadelphia County, PA

Beyond the fringe benefits.

PubMed

Moore, Alison

2009-09-03

NHS employers will be looking for savings on staff costs--but room to cut wages is limited. Perks such as cheap staff parking and workplace nurseries could be targeted for cuts. Trusts will be keen to avoid the debacle of 2006 when frontline staff were laid off. As NHS spending is fixed till 2011, trusts have time to prepare--and find new ways of working.

Physician Engagement in Improving Operative Supply Chain Efficiency Through Review of Surgeon Preference Cards.

PubMed

Harvey, Lara F B; Smith, Katherine A; Curlin, Howard

To reduce operative costs involved in the purchase, packing, and transport of unnecessary supplies by improving the accuracy of surgeon preference cards. Quality improvement study (Canadian Task Force classification II-3). Gynecologic surgery suite of an academic medical center. Twenty-one specialized and generalist gynecologic surgeons. The preference cards of up to the 5 most frequently performed procedures per surgeon were selected. A total of 81 cards were distributed to 21 surgeons for review. Changes to the cards were communicated to the operating room charge nurse and finalized. Fourteen surgeons returned a total of 48 reviewed cards, 39 of which had changes. A total of 109 disposable supplies were removed from these cards, at a total cost savings of $767.67. The cost per card was reduced by $16 on average for disposables alone. Three reusable instrument trays were also eliminated from the cards, resulting in savings of approximately $925 in processing costs over a 3-month period. Twenty-two items were requested by surgeons to be available on request but were not routinely placed in the room at the start of each case, at a total cost of $6,293.54. The rate of return of unused instruments to storage decreased after our intervention, from 10.1 to 9.6 instruments per case. Surgeon preference cards serve as the basis for economic decision making regarding the purchase, storing, packing, and transport of operative instruments and supplies. A one-time surgeon review of cards resulted in a decrease in the number of disposable and reusable instruments that must be stocked, transported, counted in the operating room, or returned, potentially translating into cost savings. Surgeon involvement in preference card management may reduce waste and provide ongoing cost savings. Copyright © 2017 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

20. BANKING ROOM, LOOKING SOUTH FROM NORTHWEST CORNER, SHOWING ESCALATOR ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

20. BANKING ROOM, LOOKING SOUTH FROM NORTHWEST CORNER, SHOWING ESCALATOR ENTRANCE FROM STREET ON RIGHT AND BALCONY EDGES OF TWO MEZZANINES BEYOND - Philadelphia Saving Fund Society, Twelfth & Market Streets, Philadelphia, Philadelphia County, PA

SU-D-209-04: Raise Your Table: An Effective Way to Reduce Radiation Dose for Fluoroscopy

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

Huo, D; Hoerner, M; Toskich, B

2016-06-15

Purpose: Patient table height plays an important role in estimating patient skin dose for interventional radiology (IR) procedures, because the patient’s skin location is dependent on the height of table. Variation in table height can lead to as much as 150% difference in skin dose for patient exams with similar air kerma meter readings. In our facility, IR procedural workflow was recently changed to require the IR physicians to confirm the patient table height before the procedure. The patient table height data was collected before and after this workflow change to validate the implementation of this practice. Methods: Table heightmore » information was analyzed for all procedures performed in three IR rooms, which were impacted by the workflow change, covering three months before and after the change (Aug 2015 to Jan 2016). In total, 442, 425, and 390 procedures were performed in these three rooms over this time period. There were no personnel or procedure assignment changes during the six-month period of time. Statistical analysis was performed for the average table height changes before and after the workflow change. Results: For the three IR rooms investigated, after the workflow change, the average table heights were increased by 1.43 cm (p=0.004084), 0.66 cm (p=0.187089), and 1.59 cm (p=0.002193), providing a corresponding estimated skin dose savings of 6.76%, 2.94% and 7.62%, respectively. After the workflow change, the average table height was increased by 0.95 cm, 0.63 cm, 0.55 cm, 1.07 cm, 1.12 cm, and 3.36 cm for the six physicians who routinely work in these three rooms. Conclusion: Consistent improvement in table height settings has been observed for all IR rooms and all physicians following a simple workflow change. This change has led to significant patient dose savings by making physicians aware of the pre-procedure table position.« less

[The hybrid operating room. Home of high-end intraoperative imaging].

PubMed

Gebhard, F; Riepl, C; Richter, P; Liebold, A; Gorki, H; Wirtz, R; König, R; Wilde, F; Schramm, A; Kraus, M

2012-02-01

A hybrid operating room must serve the medical needs of different highly specialized disciplines. It integrates interventional techniques for cardiovascular procedures and allows operations in the field of orthopaedic surgery, neurosurgery and maxillofacial surgery. The integration of all steps such as planning, documentation and the procedure itself saves time and precious resources. The best available imaging devices and user interfaces reduce the need for extensive personnel in the OR and facilitate new minimally invasive procedures. The immediate possibility of postoperative control images in CT-like quality enables the surgeon to react to problems during the same procedure without the need for later revision.

32. DETAIL OF BOARD ROOM CHAIR WITH SILVER PLATE LISTING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

32. DETAIL OF BOARD ROOM CHAIR WITH SILVER PLATE LISTING NAMES AND DATES OF PAST OCCUPANTS AND PLATE WITH NAME OF CURRENT OCCUPANT - Philadelphia Saving Fund Society, Twelfth & Market Streets, Philadelphia, Philadelphia County, PA

Automated Continuous Commissioning of Commercial Buildings

DTIC Science & Technology

2011-10-01

energy annually at the building level on two demonstration sites. Some faults would also cause issues related to thermal comfort . 2 $ Economizer...Unit (AHU) discharge air temperatures and room temperatures to deviate from their respective setpoints. This causes building thermal comfort issues...annual expenditure savings over the next three to five years. At the same time, the thermal comfort in DoD buildings would be improved to result in

Crew Field Notes: A New Tool for Planetary Surface Exploration

NASA Technical Reports Server (NTRS)

Horz, Friedrich; Evans, Cynthia; Eppler, Dean; Gernhardt, Michael; Bluethmann, William; Graf, Jodi; Bleisath, Scott

2011-01-01

The Desert Research and Technology Studies (DRATS) field tests of 2010 focused on the simultaneous operation of two rovers, a historical first. The complexity and data volume of two rovers operating simultaneously presented significant operational challenges for the on-site Mission Control Center, including the real time science support function. The latter was split into two "tactical" back rooms, one for each rover, that supported the real time traverse activities; in addition, a "strategic" science team convened overnight to synthesize the day's findings, and to conduct the strategic forward planning of the next day or days as detailed in [1, 2]. Current DRATS simulations and operations differ dramatically from those of Apollo, including the most evolved Apollo 15-17 missions, due to the advent of digital technologies. Modern digital still and video cameras, combined with the capability for real time transmission of large volumes of data, including multiple video streams, offer the prospect for the ground based science support room(s) in Mission Control to witness all crew activities in unprecedented detail and in real time. It was not uncommon during DRATS 2010 that each tactical science back room simultaneously received some 4-6 video streams from cameras mounted on the rover or the crews' backpacks. Some of the rover cameras are controllable PZT (pan, zoom, tilt) devices that can be operated by the crews (during extensive drives) or remotely by the back room (during EVAs). Typically, a dedicated "expert" and professional geologist in the tactical back room(s) controls, monitors and analyses a single video stream and provides the findings to the team, commonly supported by screen-saved images. It seems obvious, that the real time comprehension and synthesis of the verbal descriptions, extensive imagery, and other information (e.g. navigation data; time lines etc) flowing into the science support room(s) constitute a fundamental challenge to future mission operations: how can one analyze, comprehend and synthesize -in real time- the enormous data volume coming to the ground? Real time understanding of all data is needed for constructive interaction with the surface crews, and it becomes critical for the strategic forward planning process.

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

PubMed

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

2017-01-01

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

The effect of handover location on trauma theatre start time: An estimated cost saving of £131 000 per year.

PubMed

Nahas, Sam; Ali, Adam; Majid, Kiran; Joseph, Roshan; Huber, Chris; Babu, Victor

2018-02-08

The National Health Service was estimated to be in £2.45 billion deficit in 2015 to 2016. Trauma theatre utilization and efficiency has never been so important as it is estimated to cost £15/minute. Structured questionnaires were given to 23 members of staff at our Trust who are actively involved in the organization or delivery of orthopaedic trauma lists at least once per week. This was used to identify key factors that may improve theatre efficiency. Following focus group evaluation, the location of the preoperative theatre meeting was changed, with all staff involved being required to attend this. Our primary outcome measure was mean theatre start time (time of arrival in the anaesthetic room) during the 1 month immediately preceding the change and the month following the change. Theatre start time was improved on average 24 minutes (1 month premeeting and postmeeting change). This equates to a saving of £360 per day, or £131 040 per year. Changing the trauma meeting location to a venue adjacent to the trauma theatre can improve theatre start times, theatre efficiency, and therefore result in significant cost savings. Copyright © 2018 John Wiley & Sons, Ltd.

The green operating room: simple changes to reduce cost and our carbon footprint.

PubMed

Wormer, Blair A; Augenstein, Vedra A; Carpenter, Christin L; Burton, Patrick V; Yokeley, William T; Prabhu, Ajita S; Harris, Beth; Norton, Sujatha; Klima, David A; Lincourt, Amy E; Heniford, B Todd

2013-07-01

Generating over four billion pounds of waste each year, the healthcare system in the United States is the second largest contributor of trash with one-third produced by operating rooms. Our objective is to assess improvement in waste reduction and recycling after implementation of a Green Operating Room Committee (GORC) at our institution. A surgeon and nurse-initiated GORC was formed with members from corporate leadership, nursing, anesthesia, and OR staff. Initiatives for recycling opportunities, reduction of energy and water use as well as solid waste were implemented and the results were recorded. Since formation of GORC in 2008, our OR has diverted 6.5 tons of medical waste. An effort to recycle all single-use devices was implemented with annual solid waste reduction of approximately 12,860 lbs. Disposable OR foam padding was replaced with reusable gel pads at greater than $50,000 per year savings. Over 500 lbs of previously discarded batteries were salvaged from the OR and donated to charity or redistributed in the hospital ($9,000 annual savings). A "Power Down" initiative to turn off all anesthesia and OR lights and equipment not in use resulted in saving $33,000 and 234.3 metric tons of CO2 emissions reduced per year. Converting from soap to alcohol-based waterless scrub demonstrated a potential saving of 2.7 million liters of water annually. Formation of an OR committee dedicated to ecological initiatives can provide a significant opportunity to improve health care's impact on the environment and save money.

Cost Averted With Timely Fecal Microbiota Transplantation in the Management of Recurrent Clostridium difficile Infection in Alberta, Canada.

PubMed

Waye, Arianna; Atkins, Kerry; Kao, Dina

2016-10-01

Fecal microbiota transplantation (FMT) is highly effective in treating recurrent Clostridium difficile infection (RCDI). However, the ideal timing for offering FMT remains to be determined. Furthermore, the direct medical costs averted with timely FMT have not been examined. A retrospective review of the Edmonton FMT program database included patients who received FMT for RCDI (October 2012 to September 2014). They were divided into 2 groups: those who received FMT after 2 recurrences (the timely FMT group) and those who received FMT after at least 3 recurrences (the delayed FMT group). The primary outcome was the difference in direct medical costs related to hospital admissions and emergency room visits due to CDI between the 2 groups. The secondary outcomes were RCDI cure rate and duration of RCDI in each group. A total of 75 patients were included: 30 received timely FMT, whereas 45 received delayed FMT. The mean difference in hospital length of stay and emergency room visits related to CDI were 13.8 days shorter and 1.3 visits fewer with timely FMT, associated with a mean cost saving of $29,842 per patient. Sensitivity analysis was performed to examine the effect of outliers and comorbities on the differential costs, and it was found that the differences in average cost per patient were more pronounced in those with Charlson comorbidity index ≥3 compared with those with scores of 0 to 2. The cure rate was 94% (timely FMT group) and 93% (delayed FMT group). The mean duration of RCDI was 109 days (timely FMT group) and 281 days (delayed FMT group). Timely FMT can provide significant cost savings to health-care systems, especially for patients with multiple comorbidities.

Avoiding 100 new power plants by increasing efficiency of room air conditioners in India: opportunities and challenges

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

Phadke, Amol; Abhyankar, Nikit; Shah, Nihar

Electricity demand for room ACs is growing very rapidly in emerging economies such as India. We estimate the electricity demand from room ACs in 2030 in India considering factors such as weather and income growth using market data on penetration of ACs in different income classes and climatic regions. We discuss the status of the current standards, labels, and incentive programs to improve the efficiency of room ACs in these markets and assess the potential for further large improvements in efficiency and find that efficiency can be improved by over 40% cost effectively. The total potential energy savings from Roommore » AC efficiency improvement in India using the best available technology will reach over 118 TWh in 2030; potential peak demand saving is found to be 60 GW by 2030. This is equivalent to avoiding 120 new coal fired power plants of 500 MW each. We discuss policy options to complement, expand and improve the ongoing programs to capture this large potential.« less

Research and application of an intelligent control system in central air-conditioning based on energy consumption simulation

NASA Astrophysics Data System (ADS)

Cao, Ling; Che, Wenbin

2018-05-01

For the central air-conditioning energy-saving, it is common practice to use a wide range of PTD controllers in engineering to optimize energy savings. However, the shortcomings of the PTD controller have also been magnified on this issue, such as: calculation accuracy is not enough, the calculation time is too long. Particle swarm optimization has the advantage of fast convergence. This paper is based on Particle Swarm Optimization apply in PTD controller tuning parameters in order to achieve the purpose of saving energy while ensuring comfort. The algorithm proposed in this paper can adjust the weight according to the change of population fitness, reduce the weights of particles with lower fitness and enhance the weights of particles with higher fitness in the population, and fully release the population vitality. The method in this paper is validated by the TRNSYS model based on the central air-conditioning system. The experimental results show that the room temperature fluctuation is small, the overshoot is small, the adjustment speed is fast, and the energy-saving fluctuates at 10%.

Launch vehicle operations cost reduction through artificial intelligence techniques

NASA Technical Reports Server (NTRS)

Davis, Tom C., Jr.

1988-01-01

NASA's Kennedy Space Center has attempted to develop AI methods in order to reduce the cost of launch vehicle ground operations as well as to improve the reliability and safety of such operations. Attention is presently given to cost savings estimates for systems involving launch vehicle firing-room software and hardware real-time diagnostics, as well as the nature of configuration control and the real-time autonomous diagnostics of launch-processing systems by these means. Intelligent launch decisions and intelligent weather forecasting are additional applications of AI being considered.

Increasing operating room efficiency through electronic medical record analysis.

PubMed

Attaallah, A F; Elzamzamy, O M; Phelps, A L; Ranganthan, P; Vallejo, M C

2016-05-01

We used electronic medical record (EMR) analysis to determine errors in operating room (OR) time utilisation. Over a two year period EMR data of 44,503 surgical procedures was analysed for OR duration, on-time, first case, and add-on time performance, within 19 surgical specialties. Maximal OR time utilisation at our institution could have saved over 302,620 min or 5,044 hours of OR efficiency over a two year period. Most specialties (78.95%) had inaccurately scheduled procedure times and therefore used the OR more than their scheduled allotment time. Significant differences occurred between the mean scheduled surgical durations (101.38 ± 87.11 min) and actual durations (108.18 ± 102.27 min; P < 0.001). Significant differences also occurred between the mean scheduled add-on durations (111.4 ± 75.5 min) and the actual add-on scheduled durations (118.6 ± 90.1 minutes; P < 0.001). EMR quality improvement analysis can be used to determine scheduling error and bias, in order to improve efficiency and increase OR time utilisation.

Successful strategies for improving operating room efficiency at academic institutions.

PubMed

Overdyk, F J; Harvey, S C; Fishman, R L; Shippey, F

1998-04-01

In this prospective study, we evaluated the etiology of operating room (OR) delays in an academic institution, examined the impact of multidisciplinary strategies to improve OR efficiency, and established OR timing benchmarks for use in future OR efficiency studies. OR times and delay etiologies were collected for 94 cases during the initial phase of the study. Timing data and delay etiologies were analyzed, and 2 wk of multidisciplinary OR efficiency awareness education was conducted for the nursing, surgical, and anesthesia staff. After the education period, timing data were collected from 1787 cases, and monthly reports listing individual case delays and timing data were sent to the Chiefs of Service. For the first case of the day, patient in room, anesthesia ready, surgical preparation start, and procedure start time were significantly earlier (P < 0.01) in the posteducation period compared with the preeducation period, and the procedure start time for the first case of the day occurred, on average, 22 min earlier than all other procedures. For all cases combined, turnover time decreased, on average, by 16 min. Unavailability of surgeons, anesthesiologists, and residents decreased significantly (P < 0.05) as causes of OR delays. Anesthesia induction times were consistently longer for the vascular and cardiothoracic services, whereas surgical preparation time was increased for the neurosurgical and orthopedic services (P < 0.05). Identification of the etiology of OR inefficiency, combined with multidisciplinary awareness training and personal accountability, can improve OR efficiency. The time savings realized are probably most cost-effective when combined with more flexible OR staffing and improved OR scheduling. We achieved significant improvements in operating room efficiency by analyzing operating room data on causes of delays, devising strategies for minimizing the most common delays, and subsequently measuring delay data. Personal accountability, streamlining of procedures, interdisciplinary team work, and accurate data collection were all important contributors to improved efficiency.

Does a simple syringe applicator enhance bone cement set up time in knee arthroplasty?

PubMed Central

Sodhi, Nipun; Dalton, Sarah E.; Khlopas, Anton; Sultan, Assem A.; Curtis, Gannon L.; Harb, Matthew A.; Naziri, Qais; Barrington, John W.; Mont, Michael A.

2017-01-01

Background The time required for polymethylmethacrylate (PMMA) cement curing or hardening can be modified by a number of variables including the mixing technique, and the temperature and pressure at which the process is taking place. Therefore, the purpose of this study was to evaluate two different methods of PMMA application in terms of set up time. Specifically, we (I) compared the PMMA set up time of cement that remained in the mixing bowl to cement that was placed in a syringe and (II) extrapolated the associated annual cost difference on the national and individual surgeon levels. Methods The cement set up time was measured for a total of 146 consecutive patients who underwent either unicompartmental knee arthroplasty (n=136) or patellofemoral arthroplasty (n=10) between January 2016 and April 2017. One pack of PMMA powder and monomer were mixed, placed in a 300 mL small plastic bowl, and mixed with a tongue depressor. Then, 50 mL of the mixed PMMA was placed in a sterile 60 mL syringe with the tip cut to a 6-mm opening, and the syringe was used to apply the cement to the bone and the prosthesis surface. The remaining unused cement in the syringe (syringe group) and the remaining unused cement in the plastic bowl (bowl group) were removed and formed into a two separate 2 cm diameter cubes that were allowed to cure at room temperature on a sterile set of osteotomes. The two cubes of cement were timed for complete PMMA curing. A two-tailed student’s t-test was used to compare the curing time for the two groups. Annual cost differences were calculated on the national and individual surgeon level. The total number of daily cases performed and the operative time savings using the syringe applicator was used to find daily and annual cost savings. Results The mean time for the cement to set up in the bowl group was 16.8±2.1 minutes, and the mean time for cement set up in the syringe group was 15.1±1.7 minutes. Compared to the bowl group cement set up time, the syringe group set up time was significantly lower (P<0.0001). An estimated 350,000 cemented knee arthroplasties are performed each year in the United States. With 1.7 minutes saved per case, 595,000 operating room minutes per year could be saved, resulting in a nearly $71,000,000 national and $110,000 individual surgeon annual cost savings. Conclusions The results of the present study demonstrated that the utilization of a simple, inexpensive syringe applicator enhanced the cement set up time by over one and a half minutes. This may be a result of the pressure differences in the syringe applicator. In addition to the control of and precision of where the cement is placed, the syringe applicator could provide an important potential time advantage to the arthroplasty surgeon. PMID:29299472

Standard work for room entry: Linking lean, hand hygiene, and patient-centeredness.

PubMed

O'Reilly, Kristin; Ruokis, Samantha; Russell, Kristin; Teves, Tim; DiLibero, Justin; Yassa, David; Berry, Hannah; Howell, Michael D

2016-03-01

Healthcare-associated infections are costly and fatal. Substantial front-line, administrative, regulatory, and research efforts have focused on improving hand hygiene. While broad agreement exists that hand hygiene is the most important single approach to infection prevention, compliance with hand hygiene is typically only about 40%(1). Our aim was to develop a standard process for room entry in the intensive care unit that improved compliance with hand hygiene and allowed for maximum efficiency. We recognized that hand hygiene is a single step in a substantially more complicated process of room entry. We applied Lean engineering techniques to develop a standard process that included both physical steps and also standard communication elements from provider to patients and families and created a physical environment to support this. We observed meaningful improvement in the performance of the new standard as well as time savings for clinical providers with each room entry. We also observed an increase in room entries that included verbal communication and an explanation of what the clinician was entering the room to do. The design and implementation of a standardized room entry process and the creation of an environment that supports that new process has resulted in measurable positive outcomes on the medical intensive care unit, including quality, patient experience, efficiency, and staff satisfaction. Designing a process, rather than viewing tasks that need to happen in close proximity in time (either serially or in parallel) as unrelated, simplifies work for staff and results in higher compliance to individual tasks. Copyright © 2015 Elsevier Inc. All rights reserved.

Utilizing a Human Factors Nursing Worksystem Improvement Framework to Increase Nurses' Time at the Bedside and Enhance Safety.

PubMed

Probst, C Adam; Carter, Megan; Cadigan, Caton; Dalcour, Cortney; Cassity, Cindy; Quinn, Penny; Williams, Tiana; Montgomery, Donna Cook; Wilder, Claudia; Xiao, Yan

2017-02-01

The aim of this study is to increase nurses' time for direct patient care and improve safety via a novel human factors framework for nursing worksystem improvement. Time available for direct patient care influences outcomes, yet worksystem barriers prevent nurses adequate time at the bedside. A novel human factors framework was developed for worksystem improvement in 3 units at 2 facilities. Objectives included improving nurse efficiency as measured by time-and-motion studies, reducing missing medications and subsequent trips to medication rooms and improving medication safety. Worksystem improvement resulted in time savings of 16% to 32% per nurse per 12-hour shift. Requests for missing medications dropped from 3.2 to 1.3 per day. Nurse medication room trips were reduced by 30% and nurse-reported medication errors fell from a range of 1.2 to 0.8 and 6.3 to 4.0 per month. An innovative human factors framework for nursing worksystem improvement provided practical and high priority targets for interventions that significantly improved the nursing worksystem.

Avoiding 100 New Power Plants by Increasing Efficiency of Room Air Conditioners in India: Opportunities and Challenges

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

Phadke, Amol; Abhyankar, Nikit; Shah, Nihar

Electricity demand for room ACs is growing very rapidly in emerging economies such as India. We estimate the electricity demand from room ACs in 2030 in India considering factors such as weather and income growth using market data on penetration of ACs in different income classes and climatic regions. We discuss the status of the current standards, labels, and incentive programs to improve the efficiency of room ACs in these markets and assess the potential for further large improvements in efficiency and find that efficiency can be improved by over 40percent cost effectively. The total potential energy savings from Roommore » AC efficiency improvement in India using the best available technology will reach over 118 TWh in 2030; potential peak demand saving is found to be 60 GW by 2030. This is equivalent to avoiding 120 new coal fired power plants of 500 MW each. We discuss policy options to complement, expand and improve the ongoing programs to capture this large potential.« less

In-office vs. operating room procedures for recurrent respiratory papillomatosis.

PubMed

Miller, Anya J; Gardner, Glendon M

2017-01-01

We conducted a study to analyze hospital and patient costs, outcomes, and patient satisfaction among adults undergoing in-office and operating room procedures for the treatment of recurrent respiratory papillomatosis. Our final study population was made up of 17 patients-1 man and 16 women, aged 30 to 86 years (mean: 62). The mean number of in-office laser procedures per patient was 4.2, and the mean interval between procedures was 5.4 months (although 10 patients underwent only 1 office procedure); the mean number of operating room procedures was 13.5, and the mean interval between procedures was 14.3 months. An equal number of patients reported complications or adverse events with the two types of procedures-5 each. The difference in cost between the office procedure (mean: $3,413.00) and the operating room procedure (mean: $12,382.59) was almost $9,000, but these savings were offset by the fact that the office procedures needed to be performed three times as often. Patients reported slightly more anxiety and discomfort during the office procedures and, overall, they appeared to prefer the operating room procedure. We conclude that office procedures are significantly more cost-effective than operating room procedures, but their use may be limited by patient tolerance and the increased frequency of the procedure.

Progress towards Managing Residential Electricity Demand: Impacts of Standards and Labeling for Refrigerators and Air Conditioners in India

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

McNeil, Michael A.; Iyer, Maithili

The development of Energy Efficiency Standards and Labeling (EES&L) began in earnest in India in 2001 with the Energy Conservation Act and the establishment of the Indian Bureau of Energy Efficiency (BEE). The first main residential appliance to be targeted was refrigerators, soon to be followed by room air conditioners. Both of these appliances are of critical importance to India's residential electricity demand. About 15percent of Indian households own a refrigerator, and sales total about 4 million per year, but are growing. At the same time, the Indian refrigerator market has seen a strong trend towards larger and more consumptivemore » frost-free units. Room air conditioners in India have traditionally been sold to commercial sector customers, but an increasing number are going to the residential sector. Room air conditioner sales growth in India peaked in the last few years at 20percent per year. In this paper, we perform an engineering-based analysis using data specific to Indian appliances. We evaluate costs and benefits to residential and commercial sector consumers from increased equipment costs and utility bill savings. The analysis finds that, while the BEE scheme presents net benefits to consumers, there remain opportunities for efficiency improvement that would optimize consumer benefits, according to Life Cycle Cost analysis. Due to the large and growing market for refrigerators and air conditioners in India, we forecast large impacts from the standards and labeling program as scheduled. By 2030, this program, if fully implemented would reduce Indian residential electricity consumption by 55 TWh. Overall savings through 2030 totals 385 TWh. Finally, while efficiency levels have been set for several years for refrigerators, labels and MEPS for these products remain voluntary. We therefore consider the negative impact of this delay of implementation to energy and financial savings achievable by 2030.« less

School nurses' role in asthma management, school absenteeism, and cost savings: a demonstration project.

PubMed

Rodriguez, Eunice; Rivera, Diana Austria; Perlroth, Daniella; Becker, Edmund; Wang, Nancy Ewen; Landau, Melinda

2013-12-01

With increasing budget cuts to education and social services, rigorous evaluation needs to document school nurses' impact on student health, academic outcomes, and district funding. Utilizing a quasi-experimental design, we evaluated outcomes in 4 schools with added full-time nurses and 5 matched schools with part-time nurses in the San Jose Unified School District. Student data and logistic regression models were used to examine predictors of illness-related absenteeism for 2006-2007 and 2008-2009. We calculated average daily attendance (ADA) funding and parent wages associated with an improvement in illness-related absenteeism. Utilizing parent surveys, we also estimated the cost of services for asthma-related visits to the emergency room (ER; N = 2489). Children with asthma were more likely to be absent due to illness; however, mean absenteeism due to illness decreased when full-time nurses were added to demonstration schools but increased in comparison schools during 2008-2009, resulting in a potential savings of $48,518.62 in ADA funding (N = 6081). Parents in demonstration schools reported fewer ER visits, and the estimated savings in ER services and parent wages were significant. Full-time school nurses play an important role in improving asthma management among students in underserved schools, which can impact school absenteeism and attendance-related economic costs. © 2013, American School Health Association.

A Comparison of Two Fat Grafting Methods on Operating Room Efficiency and Costs.

PubMed

Gabriel, Allen; Maxwell, G Patrick; Griffin, Leah; Champaneria, Manish C; Parekh, Mousam; Macarios, David

2017-02-01

Centrifugation (Cf) is a common method of fat processing but may be time consuming, especially when processing large volumes. To determine the effects on fat grafting time, volume efficiency, reoperations, and complication rates of Cf vs an autologous fat processing system (Rv) that incorporates fat harvesting and processing in a single unit. We performed a retrospective cohort study of consecutive patients who underwent autologous fat grafting during reconstructive breast surgery with Rv or Cf. Endpoints measured were volume of fat harvested (lipoaspirate) and volume injected after processing, time to complete processing, reoperations, and complications. A budget impact model was used to estimate cost of Rv vs Cf. Ninety-eight patients underwent fat grafting with Rv, and 96 patients received Cf. Mean volumes of lipoaspirate (506.0 vs 126.1 mL) and fat injected (177.3 vs 79.2 mL) were significantly higher (P < .0001) in the Rv vs Cf group, respectively. Mean time to complete fat grafting was significantly shorter in the Rv vs Cf group (34.6 vs 90.1 minutes, respectively; P < .0001). Proportions of patients with nodule and cyst formation and/or who received reoperations were significantly less in the Rv vs Cf group. Based on these outcomes and an assumed per minute operating room cost, an average per patient cost savings of $2,870.08 was estimated with Rv vs Cf. Compared to Cf, the Rv fat processing system allowed for a larger volume of fat to be processed for injection and decreased operative time in these patients, potentially translating to cost savings. LEVEL OF EVIDENCE 3. © 2016 The American Society for Aesthetic Plastic Surgery, Inc.

'Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment.

PubMed

Ragoschke-Schumm, Andreas; Yilmaz, Umut; Kostopoulos, Panagiotis; Lesmeister, Martin; Manitz, Matthias; Walter, Silke; Helwig, Stefan; Schwindling, Lenka; Fousse, Mathias; Haass, Anton; Garner, Dominique; Körner, Heiko; Roumia, Safwan; Grunwald, Iris; Nasreldein, Ali; Halmer, Ramona; Liu, Yang; Schlechtriemen, Thomas; Reith, Wolfgang; Fassbender, Klaus

2015-01-01

For patients with acute ischemic stroke, intra-arterial treatment (IAT) is considered to be an effective strategy for removing the obstructing clot. Because outcome crucially depends on time to treatment ('time-is-brain' concept), we assessed the effects of an intervention based on performing all the time-sensitive diagnostic and therapeutic procedures at a single location on the delay before intra-arterial stroke treatment. Consecutive acute stroke patients with large vessel occlusion who obtained IAT were evaluated before and after implementation (April 26, 2010) of an intervention focused on performing all the diagnostic and therapeutic measures at a single site ('stroke room'). After implementation of the intervention, the median intervals between admission and first angiography series were significantly shorter for 174 intervention patients (102 min, interquartile range (IQR) 85-120 min) than for 81 control patients (117 min, IQR 89-150 min; p < 0.05), as were the intervals between admission and clot removal or end of angiography (152 min, IQR 123-185 min vs. 190 min, IQR 163-227 min; p < 0.001). However, no significant differences in clinical outcome were observed. This study shows for the, to our knowledge, first time that for patients with acute ischemic stroke, stroke diagnosis and treatment at a single location ('stroke room') saves crucial time until IAT. © 2015 S. Karger AG, Basel.

A novel ZrHIO6ṡ4H2O catalyst for degradation of organic dyes at room temperature

NASA Astrophysics Data System (ADS)

Li, Jiayin; Ma, Xinping; Qian, Meifan; Liu, Haoran; Liu, Qiying; Zhao, Caixian; Tian, Li; Chen, Lijuan; Tang, Jianting

It is interesting to obtain catalysts to degrade organic dye pollutants at room temperature for simultaneous purposes of environment-treating and energy-saving. In this work, a novel ZrHIO6ṡ4H2O catalyst was synthesized by reacting ZrO(NO3)2 with H5IO6 in aqueous nitric acid. The catalyst was found effective in degradation of rhodamine B (RhB) or methylene blue (MB) dyes at room temperature without light illumination. We used the ultraviolet-visible (UV-Vis) absorption spectra of dye solution as well as X-ray photoelectron spectroscopy (XPS) of ZrHIO6ṡ4H2O to confirm that the dye degradation was due to its catalytic role. Importantly, the ZrHIO6ṡ4H2O catalyst can be recycled five times without obvious activity loss and it achieved higher mineralization efficiency than the previously reported analogue in the degradation experiments.

4. VIEW OF BLUBBERING ROOM Each skin was put on ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. VIEW OF BLUBBERING ROOM Each skin was put on a metal mold and stripped of its blubber with a curved knife. The blubber ran off to the left to barrels outside, where it was saved for use in preserving the texture of the skins. - Sealing Plant, St. George Island, Pribilof Islands, Saint George, Aleutians West Census Area, AK

Operating room waste reduction in plastic and hand surgery.

PubMed

Albert, Mark G; Rothkopf, Douglas M

2015-01-01

Operating rooms (ORs), combined with labour and delivery suites, account for approximately 70% of hospital waste. Previous studies have reported that recycling can have a considerable financial impact on a hospital-wide basis; however, its importance in the OR has not been demonstrated. To propose a method of decreasing cost through judicious selection of instruments and supplies, and initiation of recycling in plastic and hand surgery. The authors identified disposable supplies and instruments that are routinely opened and wasted in common plastic and hand surgery procedures, and calculated the savings that can result from eliminating extraneous items. A cost analysis was performed, which compared the expense of OR waste versus single-stream recycling and the benefit of recycling HIPAA documents and blue wrap. Fifteen total items were removed from disposable plastic packs and seven total items from hand packs. A total of US$17,381.05 could be saved per year from these changes alone. Since initiating single-stream recycling, the authors' institution has saved, on average, US$3,487 per month at the three campuses. After extrapolating at the current savings rate, one would expect to save a minimum of US$41,844 per year. OR waste reduction is an effective method of decreasing cost in the surgical setting. By revising the contents of current disposable packs and instrument sets designated for plastic and hand surgery, hospitals can reduce the amount of opened and unused material. Significant financial savings and environmental benefit can result from this judicious supply and instrument selection, as well as implementation of recycling.

Time Savings with Rituximab Subcutaneous Injection versus Rituximab Intravenous Infusion: A Time and Motion Study in Eight Countries

PubMed Central

De Cock, Erwin; Kritikou, Persefoni; Sandoval, Mariana; Tao, Sunning; Wiesner, Christof; Carella, Angelo Michele; Ngoh, Charles; Waterboer, Tim

2016-01-01

Background Rituximab is a standard treatment for non-Hodgkin lymphoma. The SABRINA trial (NCT01200758) showed that a subcutaneous (SC) rituximab formulation did not compromise efficacy or safety compared with intravenous (IV) infusion. We aimed to quantify active healthcare professional (HCP) time and patient chair time for rituximab SC and IV, including potential time savings. Methods This non-interventional time and motion study was run in eight countries and 30 day oncology units. Rituximab SC data were collected alongside the MabCute trial (NCT01461928); IV data were collected per routine real-world practice. Trained observers recorded active HCP time for pre-specified tasks (stopwatch) and chair time (time of day). A random intercept model was used to analyze active HCP time (by task and for all tasks combined) in the treatment room and drug preparation area, drug administration duration, chair time and patient treatment room time by country and/or across countries. Active HCP and chair time were extrapolated to a patient’s first year of treatment (11 rituximab sessions). Results Mean active HCP time was 35.0 and 23.7 minutes for IV and SC process, respectively (-32%, p <0.0001). By country, relative reduction in time was 27–58%. Absolute reduction in extrapolated active HCP time (first year of treatment) was 1.1–5.2 hours. Mean chair time was 262.1 minutes for IV, including 180.9 minutes infusion duration, vs. 67.3 minutes for SC, including 8.3 minutes SC injection administration (-74%, p <0.0001). By country, relative reduction was 53–91%. Absolute reduction in extrapolated chair time for the first year of treatment was 3.1–5.5 eight-hour days. Conclusions Compared with rituximab IV, rituximab SC was associated with reduced chair time and active HCP time. The latter could be invested in other activities, whereas the former may lead to more available appointments, reducing waiting lists and increasing the efficiency of day oncology units. Trial Registration ClinicalTrials.gov NCT01200758 PMID:27362533

SBIR Phase II Final Report - Multi-Protocol Energy Management Gateway for Home-Area Networks

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

Hanna, Jason

Significant amounts of electricity, natural gas, and heating oil are wasted by homeowners due to inefficient operation and inadequate maintenance of heating, ventilation, and air conditioning (HVAC) equipment. Coincident’s work under this award reduces energy waste, saves consumers money, and reduces carbon emissions. It does so in three ways: First, Coincident’s approach replaces the traditional thermostat with a wireless network of sensors and controllers that measure temperature, humidity and occupancy in multiple rooms in the house. The “Internet of Things” is a technology trend holding the promise of ubiquitous inexpensive sensors. The reality, however, is that energy and HVAC monitoringmore » and management is a patchwork of incompatible protocols and expensive proprietary technologies. Coincident’s multi-protocol architecture, developed in part under this award tackles this problem and brings low cost interoperable sensor and control devices to market. Second, the Coincident system eliminates hard-to-program and rigid thermostat schedules and instead provides automatic operation of heating and cooling by combining individual temperature and comfort preferences with energy-saving targets, real-time utility use information, weather data, and room utilization patterns. Energy efficiency technology must be appealing to consumers otherwise it will not be used. The Coincident user interface has engaging features such as remote control from any smart phone or web browser and per-room performance breakdowns. Expected energy savings resulting from more efficient operation of heating and air conditioning equipment are in the range of 10-20%. Third, the Coincident system provides heating and air-conditioning contractors with fine-grained performance data for every residence they support (subject to customer privacy controls). This data is integrated from diverse networks within the residence and includes HVAC performance and fuel use data. This information allows the partner to validate energy savings and identify potential system faults (whether from installation problems or maintenance issues). When combined with professional installation as part of high-efficiency HVAC upgrade, energy savings levels of 20-30% can be achieved. Economic feasibility of energy efficiency technology is one of the key challenges addressed in this award. The Coincident system is engineered to be delivered at a disruptive price point, making the system financially feasible for new and retrofit homes of all types and sizes. The Coincident system is intended to be sold through the HVAC professional—the industry most capable of improving HVAC efficiency. Providing HVAC contractors with detailed home performance data motivates them to sell the product, provides them with maintenance and upgrade revenue opportunities, and therefore delivers customer savings and environmental benefits. Having demonstrated technical and financial feasibility, Coincident has won additional grants and awards, participated in pilot projects, started partnership discussions with several HVAC equipment vendors, and has lined up several large channel partners ready to participate in large pilot rollouts.« less

Development of a web based monitoring system for safety and activity analysis in operating theatres.

PubMed

Frosini, Francesco; Miniati, Roberto; Avezzano, Paolo; Cecconi, Giulio; Dori, Fabrizio; Gentili, Guido Biffi; Belardinelli, Andrea

2016-01-01

The management and the monitoring of the operating rooms on the part of the general management have the objective of optimizing their use and maximizing the internal safety. The expenses owed to their safe use represent, besides reimbursements coming from the surgical activity, important factors for the analysis of the medical facility. Given that it is not possible to reduce the safety, it is necessary to develop supporting systems with the aim to enhance and optimize the use of the rooms. The developed analysis model of the operating rooms in this study is based on the specific performance indicators and allows the effective monitoring of both the parameters that influence the safety (environmental, microbiological parameters) and those that influence the efficiency of the usage (employment rate, delays, necessary formalities, etc.). This allows you to have a systematic dashboard on hand for all of the OTs and, thus, organize the intervention schedules and more appropriate improvements. A monitoring dashboard has been achieved, accessible from any platform and any device, capable of aggregating hospital information. The undertaken organizational modifications, through the use of the dashboard, have allowed for an average annual savings of 29.52 minutes per intervention and increase the use of the ORs of 5%. The increment of the employment rate and the optimization of the operating room have allowed for savings of around $299,88 for every intervention carried out in 2013, corresponding to an annual savings of $343,362,60. Integration dashboards, as the one proposed in this study as a prototype, represent a governance model of economically sustainable healthcare systems capable of guiding the hospital management in the choices and in the implementation of the most efficient organizational modifications.

Web-based video monitoring of CT and MRI procedures

NASA Astrophysics Data System (ADS)

Ratib, Osman M.; Dahlbom, Magdalena; Kho, Hwa T.; Valentino, Daniel J.; McCoy, J. Michael

2000-05-01

A web-based video transmission of images from CT and MRI consoles was implemented in an Intranet environment for real- time monitoring of ongoing procedures. Images captured from the consoles are compressed to video resolution and broadcasted through a web server. When called upon, the attending radiologists can view these live images on any computer within the secured Intranet network. With adequate compression, these images can be displayed simultaneously in different locations at a rate of 2 to 5 images/sec through standard LAN. The quality of the images being insufficient for diagnostic purposes, our users survey showed that they were suitable for supervising a procedure, positioning the imaging slices and for routine quality checking before completion of a study. The system was implemented at UCLA to monitor 9 CTs and 6 MRIs distributed in 4 buildings. This system significantly improved the radiologists productivity by saving precious time spent in trips between reading rooms and examination rooms. It also improved patient throughput by reducing the waiting time for the radiologists to come to check a study before moving the patient from the scanner.

Improving operating room schedules.

PubMed

Li, Fei; Gupta, Diwakar; Potthoff, Sandra

2016-09-01

Operating rooms (ORs) in US hospitals are costly to staff, generate about 70 % of a hospital's revenues, and operate at a staffed-capacity utilization of 60-70 %. Many hospitals allocate blocks of OR time to individual or groups of surgeons as guaranteed allocation, who book surgeries one at a time in their blocks. The booking procedure frequently results in unused time between surgeries. Realizing that this presents an opportunity to improve OR utilization, hospitals manually reschedule surgery start times one or two days before each day of surgical operations. The purpose of rescheduling is to decrease OR staffing costs, which are determined by the number of concurrently staffed ORs. We formulate the rescheduling problem as a variant of the bin-packing problem with interrelated items, which are the surgeries performed by the same surgeon. We develop a lower bound (LB) construction algorithm and prove that the LB is at least (2/3) of the optimal staffing cost. A key feature of our approach is that we allow hospitals to have two shift lengths. Our analytical results form the basis of a branch-and-bound algorithm, which we test on data obtained from three hospitals. Experiments show that rescheduling saves significant staffing costs.

33. SOLARIUM AND TERRACE IN EXECUTIVE SUITE LOOKING NORTH PAST ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

33. SOLARIUM AND TERRACE IN EXECUTIVE SUITE LOOKING NORTH PAST SLIDING GLASS WALL THAT DIVIDES SOLARIUM FROM EXECUTIVE DINING ROOM - Philadelphia Saving Fund Society, Twelfth & Market Streets, Philadelphia, Philadelphia County, PA

Effects of operational decisions on the diffusion of epidemic disease: A system dynamics modeling of the MERS-CoV outbreak in South Korea.

PubMed

Shin, Nina; Kwag, Taewoo; Park, Sangwook; Kim, Yon Hui

2017-05-21

We evaluated the nosocomial outbreak of Middle East Respiratory Syndrome (MERS) Coronavirus (CoV) in the Republic of Korea, 2015, from a healthcare operations management perspective. Establishment of healthcare policy in South Korea provides patients' freedom to select and visit multiple hospitals. Current policy enforces hospitals preference for multi-patient rooms to single-patient rooms, to lower financial burden. Existing healthcare systems tragically contributed to 186 MERS outbreak cases, starting from single "index patient" into three generations of secondary infections. By developing a macro-level health system dynamics model, we provide empirical knowledge to examining the case from both operational and financial perspectives. In our simulation, under base infectivity scenario, high emergency room occupancy circumstance contributed to an estimated average of 101 (917%) more infected patients, compared to when in low occupancy circumstance. Economic patient room design showed an estimated 702% increase in the number of infected patients, despite the overall 98% savings in total expected costs compared to optimal room design. This study provides first time, system dynamics model, performance measurements from an operational perspective. Importantly, the intent of this study was to provide evidence to motivate public, private, and government healthcare administrators' recognition of current shortcomings, to optimize performance as a whole system, rather than mere individual aspects. Copyright © 2017 Elsevier Ltd. All rights reserved.

Optimizing Anesthesia-Related Waste Disposal in the Operating Room: A Brief Report.

PubMed

Hubbard, Richard M; Hayanga, Jeremiah A; Quinlan, Joseph J; Soltez, Anita K; Hayanga, Heather K

2017-10-01

Misappropriation of noncontaminated waste into regulated medical waste (RMW) containers is a source of added expense to health care facilities. The operating room is a significant contributor to RMW waste production. This study sought to determine whether disposing of anesthesia-related waste in standard waste receptacles before patient entry into the operating room would produce a reduction in RMW. A median of 0.35 kg of waste was collected from 51 cases sampled, with a potential annual reduction of 13,800 kg of RMW to the host institution, and a cost savings of $2200.

Grace Under Fire: The Army Nurses of Pearl Harbor, 1941.

PubMed

Milbrath, Gwyneth R

2016-01-01

Much has been written about the military events of December 7, 1941; however, little has been documented about the nurses' work and experience at Pearl Harbor, Hawaii. The aerial assault on Pearl Harbor was the first time in US history that Army nurses had been on the front line of battle. Nurses quickly triaged and stabilized those who could be saved, and provided compassion and comfort to those who were dying, in an environment where the nurses were unsure of their own survival. Traditional historical methods and a social history framework were used in this investigation. Primary sources included oral histories from the US Army Medical Department Center of History and Heritage and the State of Hawaii's website, Hawaii Aviation. Secondary sources included published books, newspaper articles, military websites, and history texts. Due to the limited bed capacity, Hickam Field Hospital converted to an evacuation hospital. Nurses, physicians, and medical corpsman triaged, stabilized, and transported those likely to survive, while staging the dead behind the building. The emergency room at Tripler Hospital was quickly flooded with patients from the battlefield, but the staff was able to sort patients appropriately to the wards, to the operating room, or provide comfort care as they died. At Schofield Hospital, collaboration between tireless doctors, nurses, and corpsmen was key to providing life-saving surgery and care.

USACE Takes Going Green to New Heights

DTIC Science & Technology

2010-08-01

building of the same size—a savings of 4.5 mil- lion gallons of drinking water annually. To accomplish this, low-flow faucets , urinals, and showerheads... conserved with the help of room occupancy sensors that will automatically turn lights on and off, depending on whether a room is being occupied. Natural...round for the personnel. To conserve this air, large windows in the complex will be highly insulated to prevent air from leak- ing outside the

75 FR 30407 - Agency Information Collection Activities: Proposed Collection: Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-01

... administration or clinical psychology through September 30, 1998. Eligible lenders, such as banks, savings and... Officer, Room 10-33, Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857. Written comments should be...

Evaluation of Water consumption and savings achieved in Datacenters through Air side Economization

NASA Astrophysics Data System (ADS)

Mishra, Ravi

Recent researches and a few facility owners have focused on eliminating the chiller plant altogether by implementing 'Evaporative Cooling', as an alternative or augmentation to compressor-based air conditioning since the energy consumption is dominated by the compressor work (around 41%) in the chiller plant. Because evaporative cooling systems consume water, when evaluating the energy savings potential of these systems, it is imperative to consider not just their impacts on electricity use, but also their impacts on water consumption as well since Joe Kava, Google's head of data center operations, was quoted as saying that water is the "big elephant in the room" for data center companies. The objective of this study was to calculate the savings achieved in water consumption when these evaporative cooling systems were completely or partially marginalized when the facility is strictly working in the Economizer mode also known as 'free cooling' considering other modes of cooling required only for a part of the time when outside temperature, humidity and pollutant level were unfavorable causing improper functioning and reliability issues. The analysis was done on ASHRAE climatic zones with the help of TMY-3 weather data.

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.

[Economic impact of strategies using ephedrine prefilled syringes].

PubMed

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

2013-11-01

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

SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department.

PubMed

Humphries, Laura S; Shenaq, Deana S; Teven, Chad M; Park, Julie E; Song, David H

2018-01-01

We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution. We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents. Material costs of existing OR trays were used to estimate the purchasing and use-cost of a custom on-site tray for the same procedures. Cost of per procedure 'consult time' was estimated using procedure and resident salary. Sixteen bedside procedures were completed over a 4.5 month period. A mean of 2.14 disposable kits were used per-procedure. Mean consultation time was 1.66 hours. Procedures that used OR trays took 3 times as long as procedures that used on-site kits (4 vs. 1.1 hours). Necessary, additional instruments were unavailable for 75% of procedures. Mean cost of using disposable kits and OR trays was $115.03/procedure versus an estimated $26.67/procedure cost of using a custom tray, yielding $88.36/procedure cost-savings. Purchase of a single custom tray ($1,421.55) would be redeemed after 2.3 weeks at 1 procedure/day. Purchasing 4 trays has projected annual cost-savings of $26,565.20. The purchase of specialized procedure trays will yield valuable time and cost-savings while providing quality patient care. Improving time efficiency will help achieve the Accreditation Council of Graduate Medical Education (ACGME) goals of maintaining resident well-being and developing quality improvement competency.

Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty.

PubMed

O'Reilly, Eamon B; Barnett, Sam; Madden, Christopher; Welch, Babu; Mickey, Bruce; Rozen, Shai

2015-03-01

Traditional cranioplasty methods focus on pre-operative or intraoperative hand molding. Recently, CT-guided polyether ether ketone (PEEK) plate reconstruction enables precise, time-saving reconstruction. This case series aims to show a single institution experience with use of PEEK cranioplasty as an effective, safe, precise, reusable, and time-saving cranioplasty technique in large, complex cranial defects. We performed a 6-year retrospective review of cranioplasty procedures performed at our affiliated hospitals using PEEK implants. A total of nineteen patients underwent twenty-two cranioplasty procedures. Pre-operative, intra-operative, and post-operative data was collected. Nineteen patients underwent twenty-two procedures. Time interval from injury to loss of primary cranioplasty averaged 57.7 months (0-336 mo); 4.0 months (n=10, range 0-19) in cases of trauma. Time interval from primary cranioplasty loss to PEEK cranioplasty was 11.8 months for infection (n=11, range 6-25 mo), 12.2 months for trauma (n=5, range 2-27 mo), and 0.3 months for cosmetic or functional reconstructions (n=3, range 0-1). Similar surgical techniques were used in all patients. Drains were placed in 11/22 procedures. Varying techniques were used in skin closure, including adjacent tissue transfer (4/22) and free tissue transfer (1/22). The PEEK plate required modification in four procedures. Three patients had reoperation following PEEK plate reconstruction. Cranioplasty utilizing CT-guided PEEK plate allows easy inset, anatomic accuracy, mirror image aesthetics, simplification of complex 3D defects, and potential time savings. Additionally, it's easily manipulated in the operating room, and can be easily re-utilized in cases of intraoperative course changes or infection. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Oak ridge national laboratory automated clean chemistry for bulk analysis of environmental swipe samples

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

Bostick, Debra A.; Hexel, Cole R.; Ticknor, Brian W.

2016-11-01

To shorten the lengthy and costly manual chemical purification procedures, sample preparation methods for mass spectrometry are being automated using commercial-off-the-shelf (COTS) equipment. This addresses a serious need in the nuclear safeguards community to debottleneck the separation of U and Pu in environmental samples—currently performed by overburdened chemists—with a method that allows unattended, overnight operation. In collaboration with Elemental Scientific Inc., the prepFAST-MC2 was designed based on current COTS equipment that was modified for U/Pu separations utilizing Eichrom™ TEVA and UTEVA resins. Initial verification of individual columns yielded small elution volumes with consistent elution profiles and good recovery. Combined columnmore » calibration demonstrated ample separation without crosscontamination of the eluent. Automated packing and unpacking of the built-in columns initially showed >15% deviation in resin loading by weight, which can lead to inconsistent separations. Optimization of the packing and unpacking methods led to a reduction in the variability of the packed resin to less than 5% daily. The reproducibility of the automated system was tested with samples containing 30 ng U and 15 pg Pu, which were separated in a series with alternating reagent blanks. These experiments showed very good washout of both the resin and the sample from the columns as evidenced by low blank values. Analysis of the major and minor isotope ratios for U and Pu provided values well within data quality limits for the International Atomic Energy Agency. Additionally, system process blanks spiked with 233U and 244Pu tracers were separated using the automated system after it was moved outside of a clean room and yielded levels equivalent to clean room blanks, confirming that the system can produce high quality results without the need for expensive clean room infrastructure. Comparison of the amount of personnel time necessary for successful manual vs. automated chemical separations showed a significant decrease in hands-on time from 9.8 hours to 35 minutes for seven samples, respectively. This documented time savings and reduced labor translates to a significant cost savings per sample. Overall, the system will enable faster sample reporting times at reduced costs by limiting personnel hours dedicated to the chemical separation.« less

Legal Aspects of Fuel Shortage

ERIC Educational Resources Information Center

Hill, Frederick W.

1974-01-01

School administrators are advised to get legal authorization now for as much maneuvering room as can be worked out with vendors of heating fuels and gasoline for school buses. Safeguards for saving gasoline and anti-freeze are outlined. (Author/MF)

Types of Blood Donations

MedlinePlus

... Blood Donation Programs Advertise With Us Sponsorship Opportunities Education. Advocacy. Innovation. What We Do Board of Directors Staff Our Member Blood Centers Our Partners Foundation for America's Blood Centers ADRP Donate blood and save someone's ... ROOM BLOG CAREERS CONTACT 2018 Summer ...

What Happens in the Emergency Room?

MedlinePlus

... all of this information is recorded in the computer and saved. injection: a shot IV: intravenous catheter, which is a thin plastic tube inserted into your vein to give you medicine papoose: a soft board with Velcro straps that ...

The role of the physical environment in crossing the quality chasm.

PubMed

Henriksen, Kerm; Isaacson, Sandi; Sadler, Blair L; Zimring, Craig M

2007-11-01

Evidence-based design findings are available to help inform hospital decision makers of opportunities for ensuring that quality and safety are designed into new and refurbished facilities. The Institute of Medicine's six quality aims of patient centeredness, safety, effectiveness, efficiency, timeliness, and equity provide an organizing framework for introducing a representative portion of the evidence. Design improvements include single-bed and variable-acuity rooms; electronic access to medical records; greater accommodation for families and visitors; handrails to prevent patient falls; standardization (room layout, equipment, and supplies for improved efficiencies); improved work process flow to reduce delays and wait times; and better assessment of changing demographics, disease conditions, and community needs for appropriately targeted health care services. A recent analysis of the business case suggests that a slight, one-time incremental cost for ensuring safety and quality would be paid back in two to three years in the form of operational savings and increased revenues. Hospitals leaders anticipating new construction projects should take advantage of evidence-based design findings that have the potential of raising the quality of acute care for decades to come.

Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures.

PubMed

Martin, Jacob A; Mayhew, Christopher R; Morris, Amanda J; Bader, Angela M; Tsai, Mitchell H; Urman, Richard D

2018-04-01

Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway. We built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room. TDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re-organization of staff required to execute a carpal tunnel release.

Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures

PubMed Central

Martin, Jacob A.; Mayhew, Christopher R.; Morris, Amanda J.; Bader, Angela M.; Tsai, Mitchell H.; Urman, Richard D.

2018-01-01

Background Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. Methods In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway. Results We built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room. Conclusions TDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re-organization of staff required to execute a carpal tunnel release. PMID:29511420

Don't Give 'Em the Slip.

ERIC Educational Resources Information Center

Cohen, Andrew

1994-01-01

Discusses the selection criteria for athletic-facility locker-room flooring that will provide safety, ease of maintenance, and cost savings. Comparative comments are provided on ceramic tile, carpeting, epoxy quartz, coated concrete, rubber flooring, flow-thru tile, and terrazzo. (GR)

The Junior Professor's Dilemma: How to Save Your Own Career

ERIC Educational Resources Information Center

Nitzsche, Jane Chance

1978-01-01

Suggestions for the young professor are offered--from teaching to socializing to publishing, from classroom performance to locker-room politics, and from proper dress to how to get the most out of a conference. (Author/LBH)

Get the Most out of Your AV System Dollar. Part II

ERIC Educational Resources Information Center

Wadsworth, Raymond H.

1974-01-01

Describes how to save money when designing AV facilities; excellent viewing from all seats is achieved by applying certain basic principles to the design of the room and the selection of the equipment. (Author/MLF)

Telemedicine Consultations in Oral and Maxillofacial Surgery: A Follow-Up Study.

PubMed

Wood, Eric W; Strauss, Robert A; Janus, Charles; Carrico, Caroline K

2016-02-01

The purpose of this study was to follow up on the previous study in evaluating the efficiency and reliability of telemedicine consultations for preoperative assessment of patients. A retrospective study of 335 patients over a 6-year period was performed to evaluate success rates of telemedicine consultations in adequately assessing patients for surgical treatment under anesthesia. Success or failure of the telemedicine consultation was measured by the ability to triage patients appropriately for the hospital operating room versus the clinic, to provide an accurate diagnosis and treatment plan, and to provide a sufficient medical and physical assessment for planned anesthesia. Data gathered from the average distance traveled and data from a previous telemedicine study performed by the National Institute of Justice were used to estimate the cost savings of using telemedicine consultations over the 6-year period. Practitioners performing the consultation were successful 92.2% of the time in using the data collected to make a diagnosis and treatment plan. Patients were triaged correctly 99.6% of the time for the clinic or hospital operating room. Most patients (98.0%) were given sufficient medical and physical assessment and were able to undergo surgery with anesthesia as planned at the clinic appointment immediately after telemedicine consultation. Most patients (95.9%) were given an accurate diagnosis and treatment plan. The estimated amount saved by providing consultation by telemedicine and eliminating in-office consultation was substantial at $134,640. This study confirms the findings from previous studies that telemedicine consultations are as reliable as those performed by traditional methods. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Heart Monitoring By Satellite

NASA Technical Reports Server (NTRS)

1978-01-01

The ambulance antenna shown is a specially designed system that allows satellite-relayed two-way communications between a moving emergency vehicle and a hospital emergency room. It is a key component of a demonstration program aimed at showing how emergency medical service can be provided to people in remote rural areas. Satellite communication permits immediate, hospital- guided treatment of heart attacks or other emergencies by ambulance personnel, saving vital time when the scene of the emergency is remote from the hospital. If widely adopted, the system could save tens of thousands of lives annually in the U.S. alone, medical experts say. The problem in conventional communication with rural areas is the fact that radio signals travel in line of sight. They may be blocked by tall buildings, hills and mountains, or even by the curvature of the Earth, so signal range is sharply limited. Microwave relay towers could solve the problem, but a complete network of repeater towers would be extremely expensive. The satellite provides an obstruction-free relay station in space.

Quantifying Behavior Driven Energy Savings for Hotels

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

Dong, Bing; Wang, Na; Hooks, Edward

2016-08-12

Hotel facilities present abundant opportunities for energy savings. In the United States, there are around 25,000 hotels that spend on an average of $2,196 on energy costs per room each year. This amounts to about 6% of the total annual hotel operating cost. However, unlike offices, there are limited studies on establishing appropriate baselines and quantifying hotel energy savings given the variety of services and amenities, unpredictable customer behaviors, and the around-the-clock operation hours. In this study, we investigate behavior driven energy savings for three medium-size (around 90,000 sf2) hotels that offer similar services in different climate zones. We firstmore » used Department of Energy Asset Scoring Tool to establish baseline models. We then conducted energy saving analysis in EnergyPlus based on a behavior model that defines the upper bound and lower bound of customer and hotel staff behavior. Lastly, we presented a probabilistic energy savings outlook for each hotel. The analysis shows behavior driven energy savings up to 25%. We believe this is the first study to incorporate behavioral factors into energy analysis for hotels. It also demonstrates a procedure to quickly create tailored baselines and identify improvement opportunities for hotels.« less

Auto identification technology and its impact on patient safety in the Operating Room of the Future.

PubMed

Egan, Marie T; Sandberg, Warren S

2007-03-01

Automatic identification technologies, such as bar coding and radio frequency identification, are ubiquitous in everyday life but virtually nonexistent in the operating room. User expectations, based on everyday experience with automatic identification technologies, have generated much anticipation that these systems will improve readiness, workflow, and safety in the operating room, with minimal training requirements. We report, in narrative form, a multi-year experience with various automatic identification technologies in the Operating Room of the Future Project at Massachusetts General Hospital. In each case, the additional human labor required to make these ;labor-saving' technologies function in the medical environment has proved to be their undoing. We conclude that while automatic identification technologies show promise, significant barriers to realizing their potential still exist. Nevertheless, overcoming these obstacles is necessary if the vision of an operating room of the future in which all processes are monitored, controlled, and optimized is to be achieved.

Optimizing MRI Logistics: Focused Process Improvements Can Increase Throughput in an Academic Radiology Department.

PubMed

O'Brien, Jeremy J; Stormann, Jeremy; Roche, Kelli; Cabral-Goncalves, Ines; Monks, Annamarie; Hallett, Donna; Mortele, Koenraad J

2017-02-01

The purpose of this study was to describe and evaluate the effect of focused process improvements on protocol selection and scheduling in the MRI division of a busy academic medical center, as measured by examination and room times, magnet fill rate, and potential revenue increases and cost savings to the department. Focused process improvements, led by a multidisciplinary team at a large academic medical center, were directed at streamlining MRI protocols and optimizing matching protocol ordering to scheduling while maintaining or improving image quality. Data were collected before (June 2013) and after (March 2015) implementation of focused process improvements and divided by subspecialty on type of examination, allotted examination time, actual examination time, and MRI parameters. Direct and indirect costs were compiled and analyzed in consultation with the business department. Data were compared with evaluated effects on selected outcome and efficiency measures, as well as revenue and cost considerations. Statistical analysis was performed using a t test. During the month of June 2013, 2145 MRI examinations were performed at our center; 2702 were performed in March 2015. Neuroradiology examinations were the most common (59% in June 2013, 56% in March 2015), followed by body examinations (25% and 27%). All protocols and parameters were analyzed and streamlined for each examination, with slice thickness, TR, and echo train length among the most adjusted parameters. Mean time per examination decreased from 43.4 minutes to 36.7 minutes, and mean room time per patient decreased from 46.3 to 43.6 minutes (p = 0.009). Potential revenue from increased throughput may yield up to $3 million yearly (at $800 net revenue per scan) or produce cost savings if the facility can reduce staffed scanner hours or the number of scanners in its fleet. Actual revenue and expense impacts depend on the facility's fixed and variable cost structure, payer contracts, MRI fleet composition, and unmet MRI demand. Focused process improvements in selecting MRI protocols and scheduling examinations significantly increased throughput in the MRI division, thereby increasing capacity and revenue. Shorter scan and department times may also improve patient experience.

Rapid developing of Ektaspeed dental film by increase of temperature.

PubMed

Fredholm, U; Julin, P

1987-01-01

Three rapid developing solutions and one standard solution were tested for contrast and fog with Ektaspeed film at temperatures ranging from 15 degrees to 30 degrees C. Temperatures below 18 degrees C were found to give extremely long developing times, more than 3 minutes with rapid developers, and were not recommended. In the interval between 21 degrees C and 24 degrees C the standard developer needed 3.5-2.5 minutes to get optimum contrast. Two rapid developers needed 1.5 minutes and the fastest 1 minute to get satisfactory contrast throughout this temperature range. A further increase of the temperature gave only a marginal time saving with the rapid solutions and was not considered worthwhile. The relation between developing time and temperature for the rapid developers had a very steep gradient below 21 degrees C, while it levelled out at room temperature. For the standard developer the time/temperature function had a more even gradient from 7.5 minutes at 15 degrees C to 1.5 minutes at 27 degrees C, i.e. an average reduction of 0.5 minute per degree. Between 27 degrees C and 30 degrees C the gradient levelled out. The fog did not increase significantly until at 30 degrees C or at more than double the optimal developing time at room temperature. Recommendations of optimal developing time of Ektaspeed film at different temperatures are given for the four tested developing solutions.

2001 contract management survey.

PubMed

2001-10-01

For the second year running, hospitals are spending more on clinical outsourcing than on business services. The Eleventh Annual Contract Services Survey shows that, in clinical areas, executives use outsourcing to acquire specialized expertise with cost savings secondary. Reducing costs and FTEs are the primary reasons for outsourcing business operations. Business service contracts are more likely to meet expectations for cost savings. Overall, satisfaction levels are up, but in some areas there's still a lot of room for improvement. This report examines current trends in outsourcing, strategies for the future, satisfaction levels, the decisionmaking process, contract features, and costs.

Flexible Space Can Save the Day.

ERIC Educational Resources Information Center

Anderson, Steve

1991-01-01

Describes how the North Indiana Conference of the United Methodist Church has designed new conference lodges and improved existing facilities to increase flexible space at its camps and conference centers. Outlines the flexible use of bedrooms/dormitories and activity rooms. Includes floor plans. (SV)

Neutron skyshine calculations for the PDX tokamak

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

Wheeler, F.J.; Nigg, D.W.

1979-01-01

The Poloidal Divertor Experiment (PDX) at Princeton will be the first operating tokamak to require a substantial radiation shield. The PDX shielding includes a water-filled roof shield over the machine to reduce air scattering skyshine dose in the PDX control room and at the site boundary. During the design of this roof shield a unique method was developed to compute the neutron source emerging from the top of the roof shield for use in Monte Carlo skyshine calculations. The method is based on simple, one-dimensional calculations rather than multidimensional calculations, resulting in considerable savings in computer time and input preparationmore » effort. This method is described.« less

[Estimation of surgical treatment capacity for managing mass casualty incidents based on time needed for life-saving emergency operations].

PubMed

Kanz, K-G; Huber-Wagner, S; Lefering, R; Kay, M; Qvick, M; Biberthaler, P; Mutschler, W

2006-04-01

The surgical treatment capacity of a hospital constitutes a significant restriction in the capability to deal with critically injured patients from multiple or mass casualty incidents (MCI). With regard to the time needed for life-saving operative interventions there are no basic reference values available in the literature, which can aid in detailed planning for management of mass casualty incidents. The data of 20,815 trauma patients, recorded in the trauma registry hosted by the German Association for Trauma Surgery DGU, were analyzed to extract the median duration of life-saving surgical interventions carried out in an operating theatre. Inclusion criteria were an ISS > or = 16 and the performance of relevant ICPM coded procedures within 6 h after trauma room admission. Orthopedic procedures as well as the placement of ICP catheters and chest tubes or performance of laparoscopies were not included. Complete data sets with the required variables were available from 9,988 trauma patients with an ISS > or = 16, and included 7,907 interventions that took place within 6 h after hospital admission. From among 1,228 patients 1,793 operations could be identified as relevant life-saving emergency operations. Acute injury to the abdomen was the major cause accounting for 54.1% of all emergency surgical procedures with a median intervention duration of 137 min followed by head injuries accounting for 26.3% with a median duration of 110 min. Interventions in the pelvis amounted to 11.5% taking an average of 136 min, 5.0% were in the thorax requiring 91 min and 3.1% major amputations with 142 min. The average cut to suture time for all emergency surgical interventions was 130 min. A prerequisite for estimating the surgical operation capacity for critically injured patients of an MCI is the number of OR teams available during and outside of the normal working hours of the hospital. The average operation time of 130 min calculated from investigation of 1,793 emergency life-saving surgical procedures provides a realistic guideline. Used in combination with the number of available OR teams the prospective treatment capacity can be estimated and projected into an actual incident admission capacity. The identification and numerical value of such significant variables are the basis for operations research and realistic planning in emergency and disaster medicine.

An emergency room decision-support program that increased physician office visits, decreased emergency room visits, and saved money.

PubMed

Navratil-Strawn, Jessica L; Hawkins, Kevin; Wells, Timothy S; Ozminkowski, Ronald J; Hartley, Stephen K; Migliori, Richard J; Yeh, Charlotte S

2014-10-01

The objective of this study was to evaluate an Emergency Room having a Decision-Support (ERDS) program designed to appropriately reduce ER use among frequent users, defined as 3 or more visits within a 12-month period. To achieve this, adults with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) were eligible to participate in the program. These included 7070 individuals who elected to enroll in the ERDS program and an equal number of matched nonparticipants who were eligible but either declined or were unreachable. Program-related benefits were estimated by comparing the difference in downstream health care utilization and expenditures between engaged and not engaged individuals after using propensity score matching to adjust for case mix differences between these groups. As a result, compared with the not engaged, engaged individuals experienced better care coordination, evidenced by a greater reduction in ER visits (P=0.033) and hospital admissions (P=0.002) and an increase in office visits (P<0.001). The program was cost-effective, with a return on investment (ROI) of 1.24, which was calculated by dividing the total program savings ($3.41 million) by the total program costs ($2.75 million). The ROI implies that for every dollar invested in this program, $1.24 was saved, most of which was for the federal Medicare program. In conclusion, the decrease in ER visits and hospital admissions and the increase in office visits may indicate the program helped individuals to seek the appropriate levels of care.

Collection of post mortem data: DVI protocols and quality assurance.

PubMed

Kvaal, Sigrid I

2006-05-15

In many countries forensic odontologists are members of the Disaster Victim Identification (DVI) team. As part of their post mortem (PM) tasks work on the incident site may include securing and preserving the dental material and evidence before transport to the mortuary. In the autopsy room the main aim is to register the PM dental status. Photographs and radiographs are essential documentations in addition to a conventional registration of the dental status. Abbreviations in the registration may be used if agreed with the ante mortem (AM) team. Dental age estimation may be an aid in the sorting process and especially in victims without previous dental treatment. Interpol has a form set as part of their DVI manual. Forensic odontologists working in pairs and checking each other will act as quality assurance (QA) as suggested by International Organization for Forensic Odonto-Stomatology (IOFOS). Direct entry into the computer program as part of the registration in the autopsy room may save time and manpower.

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis.

PubMed

Tam, Samantha; Sun, Hongmei; Sarma, Sisira; Siu, Jennifer; Fung, Kevin; Sowerby, Leigh

2017-02-20

Medialization thyroplasty and injection laryngoplasty are widely accepted treatment options for unilateral vocal fold paralysis. Although both procedures result in similar clinical outcomes, little is known about the corresponding medical care costs. Medialization thyroplasty requires expensive operating room resources while injection laryngoplasty utilizes outpatient resources but may require repeated procedures. The purpose of this study, therefore, is to quantify the cost differences in adult patients with unilateral vocal fold paralysis undergoing medialization thyroplasty versus injection laryngoplasty. Cost minimization analysis conducted using a decision tree model. A decision tree model was constructed to capture clinical scenarios for medialization thyroplasty and injection laryngoplasty. Probabilities for various events were obtained from a retrospective cohort from the London Health Sciences Centre, Canada. Costs were derived from the published literature and the London Health Science Centre. All costs were reported in 2014 Canadian dollars. Time horizon was 5 years. The study was conducted from an academic hospital perspective in Canada. Various sensitivity analyses were conducted to assess differences in procedure-specific costs and probabilities of key events. Sixty-three patients underwent medialization thyroplasty and 41 underwent injection laryngoplasty. Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19. Results showed that cost savings with IL were C$1555.91. Deterministic and probabilistic sensitivity analyses suggested cost savings ranged from C$596 to C$3626. Treatment with injection laryngoplasty results in cost savings of C$1555.91 per patient. Our extensive sensitivity analyses suggest that switching from medialization thyroplasty to injection laryngoplasty will lead to a minimum cost savings of C$596 per patient. Considering the significant cost savings and similar effectiveness, injection laryngoplasty should be strongly considered as a preferred treatment option for patients diagnosed with unilateral vocal fold paralysis.

To provide care and be cared for in a multiple-bed hospital room.

PubMed

Persson, Eva; Määttä, Sylvia

2012-12-01

To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

How To Organize Technology Areas.

ERIC Educational Resources Information Center

Fickes, Michael

1998-01-01

Highlights three ways a college or university can organize its technology areas to maximize comfort and save space. Examples are provided on controlling equipment sprawl through thoughtful workstation development, designing computer rooms for flexibility and effective cable management, and emulating business setups that are work-flow efficient and…

Home Energy Saver

Science.gov Websites

Help | About | Privacy | Media Room | Feedback Start Describe Compare Upgrade Community Press For members of the media, we've gathered some press materials issued by Berkeley Lab, including the press Energy Management Software Home Energy Saver Website Computes Possible Savings for Homeowners Media

Steamer of steam circulation system

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

Onodera, M.

1986-09-23

A conveyor steamer is described which consists of: a room enclosed with heat-insulated walls, floor, and ceiling, the room having an entrance and an exit for goods to be steamed, a conveyor means for carrying the goods to be steamed, the conveyor means traversing into the entrance of the room, through the room, and out of the exit of the room; a source of heated primary steam; first pipe means, arranged beneath the conveyor means, for jetting the heated primary steam upwardly from across the floor of the room; second pipe means disposed across the entire ceiling of the roommore » arranged above the conveyor means, for scavenging spent steam from across the entire ceiling of the room; and an ejector-condenser means, interconnected between the first pipe means, the source of primary heated steam and the second pipe means, for mixing the spent steam from the second pipe means with the heated primary steam in the first pipe means; whereby the spent steam mixed with the heated primary steam is caused to recirculate in the first pipe means through the room, thus saving energy and consuming less heated primary steam so that cost reductions will result.« less

Effect of ventilation rate on air cleanliness and energy consumption in operation rooms at rest.

PubMed

Lee, Shih-Tseng; Liang, Ching-Chieh; Chien, Tsung-Yi; Wu, Feng-Jen; Fan, Kuang-Chung; Wan, Gwo-Hwa

2018-02-27

The interrelationships between ventilation rate, indoor air quality, and energy consumption in operation rooms at rest are yet to be understood. We investigate the effect of ventilation rate on indoor air quality indices and energy consumption in ORs at rest. The study investigates the air temperature, relative humidity, concentrations of carbon dioxide, particulate matter (PM), and airborne bacteria at different ventilation rates in operation rooms at rest of a medical center. The energy consumption and cost analysis of the heating, ventilating, and air conditioning (HVAC) system in the operation rooms at rest were also evaluated for all ventilation rates. No air-conditioned operation rooms had very highest PM and airborne bacterial concentrations in the operation areas. The bacterial concentration in the operation areas with 6-30 air changes per hour (ACH) was below the suggested level set by the United Kingdom (UK) for an empty operation room. A 70% of reduction in annual energy cost by reducing the ventilation rate from 30 to 6 ACH was found in the operation rooms at rest. Maintenance of operation rooms at ventilation rate of 6 ACH could save considerable amounts of energy and achieve the goal of air cleanliness.

Guest Room Lighting at the Hilton Columbus Downtown

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

None

2014-06-30

At the Hilton Columbus Downtown hotel in Ohio, DOE's Better Buildings Alliance conducted a demonstration of Next Generation Luminaires-winning downlights installed in all guest rooms and suites prior to the hotel's 2012 opening. After a post-occupancy assessment, the LED downlights not only provided the aesthetic appearance and dimming functionality desired, but also provided 50% energy savings relative to a comparable CFL downlight and enabled the lighting power to be more than 20% below that allowed by code. This document is a summary case study of the report.

Out-Life Characteristics of IM7/977-3 Composites

NASA Technical Reports Server (NTRS)

Miller, Sandi G.; Sutter, James K.; Hou, Tan-Hung; Scheiman, Daniel A.; Martin, Richard E.; Maryanski, Michael; Schlea, Michelle; Gardner, John M.; Schiferl, Zack R.

2010-01-01

The capability to manufacture large structures leads to weight savings and reduced risk relative to joining smaller components. However, manufacture of increasingly large composite components is pushing the out-time limits of epoxy/ carbon fiber prepreg. IM7/977-3 is an autoclave processable prepreg material, commonly used in aerospace structures. The out-time limit is reported as 30 days by the manufacturer. The purpose of this work was to evaluate the material processability and composite properties of 977-3 resin and IM7/977-3 prepreg that had been aged at room temperature for up to 60 days. The effects of room temperature aging on the thermal and visco-elastic properties of the materials were investigated. Neat resin was evaluated by differential scanning calorimetry to characterize thermal properties and change in activation energy of cure. Neat resin was also evaluated by rheometry to characterize its processability in composite fabrication. IM7/977-3 prepreg was evaluated by dynamic mechanical analysis to characterize the curing behavior. Prepreg tack was also evaluated over 60 days. The overall test results suggested that IM7/977-3 was a robust material that offered quality laminates throughout this aging process when processed by autoclave.

Physical restraints versus seclusion room for management of people with acute aggression or agitation due to psychotic illness (TREC-SAVE): a randomized trial.

PubMed

Huf, G; Coutinho, E S F; Adams, C E

2012-11-01

After de-escalation techniques have failed, restraints, seclusion and/or rapid tranquillization may be used for people whose aggression is due to psychosis. Most coercive acts of health care have not been evaluated in trials. People admitted to the emergency room of Instituto Philippe Pinel, Rio de Janeiro, Brazil, whose aggression/agitation was thought due to psychosis and for whom staff were unsure if best to restrict using physical restraints or a seclusion room, were randomly allocated to one or the other and followed up to 14 days. The primary outcomes were 'no need to change intervention early - within 1 h' and 'not restricted by 4 h'. A total of 105 people were randomized. Two-thirds of the people secluded were able to be fully managed in this way. Even taking into account the move out of seclusion into restraints, this study provides evidence that embarking on the less restrictive care pathway (seclusion) does not increase overall time in restriction of some sort [not restricted by 4 h: relative risk 1.09, 95% confidence interval 0.75-1.58; mean time to release: restraints 337.6 (s.d.=298.2) min, seclusion room 316.3 (s.d.=264.5) min, p=0.48]. Participants tended to be more satisfied with their care in the seclusion group (17.0% v. 11.1%) but this did not reach conventional levels of statistical significance (p=0.42). This study should be replicated, but suggests that opting for the least restrictive option in circumstances where there is clinical doubt does not harm or prolong coercion.

A simple method to ensure proper screw position and plate size selection using the Morscher cervical spine locking plate. Technical note.

PubMed

Ball, P A; Benzel, E C; Baldwin, N G

1994-04-01

The use of bone plate instrumentation with screw fixation has proved to be a useful adjunctive measure in anterior cervical spine fusion surgery. Proper fitting, positioning, and attachment of this instrumentation have been shown to be frequently suboptimal if done without radiographic guidance. The most commonly used method of radiographic assistance for placement of this instrumentation is fluoroscopy. While this gives satisfactory technical results, it is expensive and time-consuming, and exposes the patient and the operating room personnel to ionizing radiation. The authors present a simple technique to ensure screw placement and plate fitting using Kirschner wires and a single lateral radiograph. This technique saves time, reduces exposure to radiation, and has led to satisfactory results in over 20 operative cases.

Advice and Learning in Problem Solving

DTIC Science & Technology

2005-02-01

Person op Harry : Person op Ivy : Person op DarkRoom : Room op LightRoom : Room op RedRoom : Room op OrangeRoom : Room op...Time7) & % FreeRoom(DarkRoom, Time8) axiom RedRoom_Free_Time is FreeRoom( RedRoom , Time1) & FreeRoom( RedRoom , Time2) & FreeRoom... RedRoom , Time3) & FreeRoom( RedRoom , Time4) & % FreeRoom( RedRoom , Time5) & FreeRoom( RedRoom , Time6) & FreeRoom( RedRoom , Time7) & FreeRoom

Fed Up with Delays, a President Pushes To Outsource Technology Operations.

ERIC Educational Resources Information Center

Olsen, Florence

2002-01-01

Discusses how officials at Salt Lake Community College decided the only way they could get the kind of technology service they needed was to hire a company to run the operation; the plan will not save money, but seeks better service and room for expansion. (EV)

Cold air systems: Sleeping giant

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

MacCracken, C.D.

1994-04-01

This article describes how cold air systems help owners increase the profits from their buildings by reducing electric costs and improving indoor air quality through lower relative humidity levels. Cold air distribution involves energy savings, cost savings, space savings, greater comfort, cleaner air, thermal storage, tighter ducting, coil redesign, lower relative humidities, retrofitting, and improved indoor air quality (IAQ). It opens a door for architects, engineers, owners, builders, environmentalists, retrofitters, designers, occupants, and manufacturers. Three things have held up cold air's usage: multiple fan-powered boxes that ate up the energy savings of primary fans. Cold air room diffusers that providedmore » inadequate comfort. Condensation from ducts, boxes, and diffusers. Such problems have been largely eliminated through research and development by utilities and manufacturers. New cold air diffusers no longer need fan powered boxes. It has also been found that condensation is not a concern so long as the ducts are located in air conditioned space, such as drop ceilings or central risers, where relative humidity falls quickly during morning startup.« less

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

Shah, Nihar K.; Wei, Max; Letschert, Virginie

Hydrofluorocarbons (HFCs) emitted from uses such as refrigerants and thermal insulating foam, are now the fastest growing greenhouse gases (GHGs), with global warming potentials (GWP) thousands of times higher than carbon dioxide (CO2). Because of the short lifetime of these molecules in the atmosphere,1 mitigating the amount of these short-lived climate pollutants (SLCPs) provides a faster path to climate change mitigation than control of CO2 alone. This has led to proposals from Africa, Europe, India, Island States, and North America to amend the Montreal Protocol on Substances that Deplete the Ozone Layer (Montreal Protocol) to phase-down high-GWP HFCs. Simultaneously, energymore » efficiency market transformation programs such as standards, labeling and incentive programs are endeavoring to improve the energy efficiency for refrigeration and air conditioning equipment to provide life cycle cost, energy, GHG, and peak load savings. In this paper we provide an estimate of the magnitude of such GHG and peak electric load savings potential, for room air conditioning, if the refrigerant transition and energy efficiency improvement policies are implemented either separately or in parallel.« less

Improving on-time surgical starts: the impact of implementing pre-OR timeouts and performance pay.

PubMed

Martin, Luke; Langell, John

2017-11-01

Operating room (OR) time is expensive. Underutilized OR time negatively impacts efficiency and is an unnecessary cost for hospitals. The purpose of this study was to evaluate the impact of a pre-OR timeout and performance pay incentive on the frequency of on-time, first surgical starts. At a single Veterans Affairs Medical Center, we implemented a pre-OR timeout in the form of a safety-briefing checklist and a modest performance pay incentive for on-time starts (>90% compliance) for attending surgeons. Data were collected on all first-start cases beginning before implementation in 2008 and continued through 2015. Each year, an average of 960 first starts occurred across nine surgical divisions. Before implementation of either the timeout or pay incentive, only 15% of cases started on time, and by 2015, greater than 72% were on time (P < 0.001). Over the study period, there were significant improvements in on-time starts (P = 0.01), of delays <15 min (P = 0.01), and of delays 16 to 30 min (P = 0.04). The trends for delays of 31 to 60 min or >60 min were not significant (P = 0.31; P = 0.81). Assuming a loss of 7 min per case for delays <15 min and 20 min per case for delays of 16 to 30 min, the total OR time saved from implementing these measures was 37,556 min. At an estimated cost of $20/min, gross savings from this project were $751,120. Implementation of a pre-OR timeout and performance pay for on-time starts significantly improves OR utilization and reduces unnecessary costs. Published by Elsevier Inc.

A discrete event simulation model of clinical and operating room efficiency outcomes of sugammadex versus neostigmine for neuromuscular block reversal in Canada.

PubMed

Insinga, Ralph P; Joyal, Cédric; Goyette, Alexandra; Galarneau, André

2016-11-16

The objective of this analysis is to explore potential impact on operating room (OR) efficiency and incidence of residual neuromuscular blockade (RNMB) with use of sugammadex (Bridion™, Merck & Co., Inc., Kenilworth, NJ USA) versus neostigmine for neuromuscular block reversal in Canada. A discrete event simulation (DES) model was developed to compare ORs using either neostigmine or sugammadex for NMB reversal over one month. Selected inputs included OR procedure and turnover times, hospital policies for paid staff overtime and procedural cancellations due to OR time over-run, and reductions in RNMB and associated complications with sugammadex use. Trials show sugammadex's impact on OR time and RNMB varies by whether full neuromuscular recovery (train-of-four ratio ≥0.9) is verified prior to extubation in the OR. Scenarios were therefore evaluated reflecting varied assumptions for neuromuscular reversal practices. With use of moderate neuromuscular block, when full neuromuscular recovery is verified prior to extubation (93 procedures performed with sugammadex, 91 with neostigmine), use of sugammadex versus neostigmine avoided 2.4 procedural cancellations due to OR time over-run and 33.5 h of paid staff overtime, while saving an average of 62 min per OR day. No difference was observed between comparators for these endpoints in the scenario when full neuromuscular recovery was not verified prior to extubation, however, per procedure risk of RNMB at extubation was reduced from 60% to 4% (reflecting 51 cases prevented), with associated reductions in risks of hypoxemia (12 cases avoided) and upper airway obstruction (23 cases avoided). Sugammadex impact in reversing deep neuromuscular block was evaluated in an exploratory analysis. When it was hypothetically assumed that 30 min of OR time were saved per procedure, the number of paid hours of staff over-time dropped from 84.1 to 32.0, with a 93% reduction in the per patient risk of residual blockade. In clinical practice within Canada, for the majority of patients currently managed with moderate neuromuscular block, the principal impact of substituting sugammadex for neostigmine is likely to be a reduction in the risk of residual blockade and associated complications. For patients maintained at a deep level of block to the end of the procedure, sugammadex is likely to both enhance OR efficiency and reduce residual block complications.

Wireless Occupancy Sensors for Lighting Controls: An Applications Guide for Federal Facility Managers

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

None

This guide provides federal facility managers with an overview of the energy savings potential of wireless lighting occupancy sensors for various room types, cost considerations, key steps to successful installation of wireless sensors, pros and cons of various technology options, light source considerations, and codes and standards.

C-arm positioning using virtual fluoroscopy for image-guided surgery

NASA Astrophysics Data System (ADS)

de Silva, T.; Punnoose, J.; Uneri, A.; Goerres, J.; Jacobson, M.; Ketcha, M. D.; Manbachi, A.; Vogt, S.; Kleinszig, G.; Khanna, A. J.; Wolinsky, J.-P.; Osgood, G.; Siewerdsen, J. H.

2017-03-01

Introduction: Fluoroscopically guided procedures often involve repeated acquisitions for C-arm positioning at the cost of radiation exposure and time in the operating room. A virtual fluoroscopy system is reported with the potential of reducing dose and time spent in C-arm positioning, utilizing three key advances: robust 3D-2D registration to a preoperative CT; real-time forward projection on GPU; and a motorized mobile C-arm with encoder feedback on C-arm orientation. Method: Geometric calibration of the C-arm was performed offline in two rotational directions (orbit α, orbit β). Patient registration was performed using image-based 3D-2D registration with an initially acquired radiograph of the patient. This approach for patient registration eliminated the requirement for external tracking devices inside the operating room, allowing virtual fluoroscopy using commonly available systems in fluoroscopically guided procedures within standard surgical workflow. Geometric accuracy was evaluated in terms of projection distance error (PDE) in anatomical fiducials. A pilot study was conducted to evaluate the utility of virtual fluoroscopy to aid C-arm positioning in image guided surgery, assessing potential improvements in time, dose, and agreement between the virtual and desired view. Results: The overall geometric accuracy of DRRs in comparison to the actual radiographs at various C-arm positions was PDE (mean ± std) = 1.6 ± 1.1 mm. The conventional approach required on average 8.0 ± 4.5 radiographs spent "fluoro hunting" to obtain the desired view. Positioning accuracy improved from 2.6o ± 2.3o (in α) and 4.1o ± 5.1o (in β) in the conventional approach to 1.5o ± 1.3o and 1.8o ± 1.7o, respectively, with the virtual fluoroscopy approach. Conclusion: Virtual fluoroscopy could improve accuracy of C-arm positioning and save time and radiation dose in the operating room. Such a system could be valuable to training of fluoroscopy technicians as well as intraoperative use in fluoroscopically guided procedures.

Multiple video sequences synchronization during minimally invasive surgery

NASA Astrophysics Data System (ADS)

Belhaoua, Abdelkrim; Moreau, Johan; Krebs, Alexandre; Waechter, Julien; Radoux, Jean-Pierre; Marescaux, Jacques

2016-03-01

Hybrid operating rooms are an important development in the medical ecosystem. They allow integrating, in the same procedure, the advantages of radiological imaging and surgical tools. However, one of the challenges faced by clinical engineers is to support the connectivity and interoperability of medical-electrical point-of-care devices. A system that could enable plug-and-play connectivity and interoperability for medical devices would improve patient safety, save hospitals time and money, and provide data for electronic medical records. In this paper, we propose a hardware platform dedicated to collect and synchronize multiple videos captured from medical equipment in real-time. The final objective is to integrate augmented reality technology into an operation room (OR) in order to assist the surgeon during a minimally invasive operation. To the best of our knowledge, there is no prior work dealing with hardware based video synchronization for augmented reality applications on OR. Whilst hardware synchronization methods can embed temporal value, so called timestamp, into each sequence on-the-y and require no post-processing, they require specialized hardware. However the design of our hardware is simple and generic. This approach was adopted and implemented in this work and its performance is evaluated by comparison to the start-of-the-art methods.

Allocating operating room block time using historical caseload variability.

PubMed

Hosseini, Narges; Taaffe, Kevin M

2015-12-01

Operating room (OR) allocation and planning is one of the most important strategic decisions that OR managers face. The number of ORs that a hospital opens depends on the number of blocks that are allocated to the surgical groups, services, or individual surgeons, combined with the amount of open posting time (i.e., first come, first serve posting) that the hospital wants to provide. By allocating too few ORs, a hospital may turn away surgery demand whereas opening too many ORs could prove to be a costly decision. The traditional method of determining block frequency and size considers the average historical surgery demand for each group. However, given that there are penalties to the system for having too much or too little OR time allocated to a group, demand variability should play a role in determining the real OR requirement. In this paper we present an algorithm that allocates block time based on this demand variability, specifically accounting for both over-utilized time (time used beyond the block) and under-utilized time (time unused within the block). This algorithm provides a solution to the situation in which total caseload demand can be accommodated by the total OR resource set, in other words not in a capacity-constrained situation. We have found this scenario to be common among several regional healthcare providers with large OR suites and excess capacity. This algorithm could be used to adjust existing blocks or to assign new blocks to surgeons that did not previously have a block. We also have studied the effect of turnover time on the number of ORs that needs to be allocated. Numerical experiments based on real data from a large health-care provider indicate the opportunity to achieve over 2,900 hours of OR time savings through improved block allocations.

The influence of multiple goals on driving behavior: the case of safety, time saving, and fuel saving.

PubMed

Dogan, Ebru; Steg, Linda; Delhomme, Patricia

2011-09-01

Due to the innate complexity of the task drivers have to manage multiple goals while driving and the importance of certain goals may vary over time leading to priority being given to different goals depending on the circumstances. This study aimed to investigate drivers' behavioral regulation while managing multiple goals during driving. To do so participants drove on urban and rural roads in a driving simulator while trying to manage fuel saving and time saving goals, besides the safety goals that are always present during driving. A between-subjects design was used with one group of drivers managing two goals (safety and fuel saving) and another group managing three goals (safety, fuel saving, and time saving) while driving. Participants were provided continuous feedback on the fuel saving goal via a meter on the dashboard. The results indicate that even when a fuel saving or time saving goal is salient, safety goals are still given highest priority when interactions with other road users take place and when interacting with a traffic light. Additionally, performance on the fuel saving goal diminished for the group that had to manage fuel saving and time saving together. The theoretical implications for a goal hierarchy in driving tasks and practical implications for eco-driving are discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

Boron/aluminum skins for the DC-10 aft pylon

NASA Technical Reports Server (NTRS)

Elliott, S. Y.

1975-01-01

Boron/aluminum pylon boat tail skins were designed and fabricated and installed on the DC-10 aircraft for a 5-year flight service demonstration test. Inspection and tests of the exposed skins will establish the ability of the boron/aluminum composite to withstand long time flight service conditions, which include exposure to high temperatures, sonic fatigue, and flutter. The results of a preliminary testing program yield room temperature and elevated temperature data on the tension, compression, in-plane shear, interlaminar shear, bolt bearing, and tension fatigue properties of the boron/aluminum laminates. Present technology was used in the fabrication of the skins. Although maximum weight saving was not sought, weight of the constant thickness boron/aluminum skin is 26% less than the chemically milled titanium skin.

First installation of a dual-room IVR-CT system in the emergency room.

PubMed

Wada, Daiki; Nakamori, Yasushi; Kanayama, Shuji; Maruyama, Shuhei; Kawada, Masahiro; Iwamura, Hiromu; Hayakawa, Koichi; Saito, Fukuki; Kuwagata, Yasuyuki

2018-03-05

Computed tomography (CT) embedded in the emergency room has gained importance in the early diagnostic phase of trauma care. In 2011, we implemented a new trauma workflow concept with a sliding CT scanner system with interventional radiology features (IVR-CT) that allows CT examination and emergency therapeutic intervention without relocating the patient, which we call the Hybrid emergency room (Hybrid ER). In the Hybrid ER, all life-saving procedures, CT examination, damage control surgery, and transcatheter arterial embolisation can be performed on the same table. Although the trauma workflow realized in the Hybrid ER may improve mortality in severe trauma, the Hybrid ER can potentially affect the efficacy of other in/outpatient diagnostic workflow because one room is occupied by one severely injured patient undergoing both emergency trauma care and CT scanning for long periods. In July 2017, we implemented a new trauma workflow concept with a dual-room sliding CT scanner system with interventional radiology features (dual-room IVR-CT) to increase patient throughput. When we perform emergency surgery or interventional radiology for a severely injured or ill patient in the Hybrid ER, the sliding CT scanner moves to the adjacent CT suite, and we can perform CT scanning of another in/outpatient. We believe that dual-room IVR-CT can contribute to the improvement of both the survival of severely injured or ill patients and patient throughput.

Lawyer Up

ERIC Educational Resources Information Center

Schaffhauser, Dian

2012-01-01

Putting a CIO and a lawyer together in the same room may give one the start of a pretty decent joke, but it could also save an institution millions of dollars in legal fees. While the IT chief understands the systems that fall under the purview of compliance, the attorney is the go-to pessimist for identifying the "gotcha" elements when it comes…

Research status and evaluation system of heat source evaluation method for central heating

NASA Astrophysics Data System (ADS)

Sun, Yutong; Qi, Junfeng; Cao, Yi

2018-02-01

The central heating boiler room is a regional heat source heating center. It is also a kind of the urban environment pollution, it is an important section of building energy efficiency. This article through to the evaluation method of central heating boiler room and overviews of the researches during domestic and overseas, summarized the main influence factors affecting energy consumption of industrial boiler under the condition of stable operation. According to the principle of establishing evaluation index system. We can find that is great significance in energy saving and environmental protection for the content of the evaluation index system of the centralized heating system.

Optimizing indoor illumination quality and energy efficiency using a spectrally tunable lighting system to augment natural daylight.

PubMed

Hertog, W; Llenas, A; Carreras, J

2015-11-30

This article demonstrates the benefits of complementing a daylight-lit environment with a spectrally tunable illumination system. The spectral components of daylight present in the room are measured by a low-cost miniature spectrophotometer and processed through a number of optimization algorithms, carefully trading color fidelity for energy efficiency. Spectrally-tunable luminaires provide only those wavelengths that ensure that either the final illumination spectrum inside the room is kept constant or carefully follows the dynamic spectral pattern of natural daylight. Analyzing the measured data proves that such a hybrid illumination system brings both unprecendented illumination quality and significant energy savings.

Impact of Extended Daylight Saving Time on National Energy Consumption Report to Congress

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

Belzer, D. B.; Hadley, S. W.; Chin, S-M.

2008-10-01

The Energy Policy Act of 2005 (Pub. L. No. 109-58; EPAct 2005) amended the Uniform Time Act of 1966 (Pub. L. No. 89-387) to increase the portion of the year that is subject to Daylight Saving Time. (15 U.S.C. 260a note) EPAct 2005 extended the duration of Daylight Saving Time in the spring by changing its start date from the first Sunday in April to the second Sunday in March, and in the fall by changing its end date from the last Sunday in October to the first Sunday in November. (15 U.S.C. 260a note) EPAct 2005 also called formore » the Department of Energy to evaluate the impact of Extended Daylight Saving Time on energy consumption in the United States and to submit a report to Congress. (15 U.S.C. 260a note) This report presents the results of impacts of Extended Daylight Saving Time on the national energy consumption in the United States. The key findings are: (1) The total electricity savings of Extended Daylight Saving Time were about 1.3 Tera Watt-hour (TWh). This corresponds to 0.5 percent per each day of Extended Daylight Saving Time, or 0.03 percent of electricity consumption over the year. In reference, the total 2007 electricity consumption in the United States was 3,900 TWh. (2) In terms of national primary energy consumption, the electricity savings translate to a reduction of 17 Trillion Btu (TBtu) over the spring and fall Extended Daylight Saving Time periods, or roughly 0.02 percent of total U.S. energy consumption during 2007 of 101,000 TBtu. (3) During Extended Daylight Saving Time, electricity savings generally occurred over a three- to five-hour period in the evening with small increases in usage during the early-morning hours. On a daily percentage basis, electricity savings were slightly greater during the March (spring) extension of Extended Daylight Saving Time than the November (fall) extension. On a regional basis, some southern portions of the United States exhibited slightly smaller impacts of Extended Daylight Saving Time on energy savings compared to the northern regions, a result possibly due to a small, offsetting increase in household air conditioning usage. (4) Changes in national traffic volume and motor gasoline consumption for passenger vehicles in 2007 were determined to be statistically insignificant and therefore, could not be attributed to Extended Daylight Saving Time.« less

Field Demonstration of Active Desiccant Modules Designed to Integrate with Standard Unitary Rooftop Package Equipment - Final Report: Phase 3

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

Fischer, J

2004-03-15

This report summarizes the investigation of two active desiccant module (ADM) pilot site installations initiated in 2001. Both pilot installations were retrofits at existing facilities served by conventional heating, ventilating, and air-conditioning (HVAC) systems that had encountered frequent humidity control, indoor air quality (IAQ), and other operational problems. Each installation involved combining a SEMCO, Inc., ADM (as described in Fischer and Sand 2002) with a standard packaged rooftop unit built by the Trane Company. A direct digital control (DDC) system integral to the ADM performed the dual function of controlling the ADM/rooftop combination and facilitating data collection, trending, and remotemore » performance monitoring. The first installation involved providing preconditioned outdoor air to replace air exhausted from the large kitchen hood and bathrooms of a Hooters restaurant located in Rome, Georgia. This facility had previously added an additional rooftop unit in an attempt to achieve occupant comfort without success. The second involved conditioning the outdoor air delivered to each room of a wing of the Mountain Creek Inn at the Callaway Gardens resort. This hotel, designed in the ''motor lodge'' format with each room opening to the outdoors, is located in southwest Georgia. Controlling the space humidity always presented a serious challenge. Uncomfortable conditions and musty odors had caused many guests to request to move to other areas within the resort. This is the first field demonstration performed by Oak Ridge National Laboratory where significant energy savings, operating cost savings, and dramatically improved indoor environmental conditions can all be claimed as the results of a retrofit desiccant equipment field installation. The ADM/rooftop combination installed at the restaurant resulted in a reduction of about 34% in the electricity used by the building's air-conditioning system. This represents a reduction of approximately 15% in overall electrical energy consumption and a 12.5-kW reduction in peak demand. The cost of gas used for regeneration of the desiccant wheel over this period of time is estimated to be only $740, using a gas cost of $0.50 per therm--the summer rate in 2001. The estimated net savings is $5400 annually, resulting in a 1-2 year payback. It is likely that similar energy/cost savings were realized at the Callaway Gardens hotel. In this installation, however, a central plant supplied the chilled water serving fan coil units in the hotel wing retrofitted with the ADM, so it was not metered separately. Consequently, the owner could not provide actual energy consumption data specific to the facility. The energy and operating cost savings at both sites are directly attributable to higher cooling-season thermostat settings and decreased conventional system run times. These field installations were selected as an immediate and appropriate response to correct indoor humidity and fresh air ventilation problems being experienced by building occupants and owners, so no rigorous baseline-building vs. test-building energy use/operating cost savings results can be presented. The report presents several simulated comparisons between the ADM/roof HVAC approach and other equipment combinations, where both desiccant and conventional systems are modeled to provide comparable fresh air ventilation rates and indoor humidity levels. The results obtained from these simulations demonstrate convincingly the energy and operating cost savings obtainable with this hybrid desiccant/vapor-compression technology, verifying those actually seen at the pilot installations. The ADM approach is less expensive than conventional alternatives providing similar performance and indoor air quality and provides a very favorable payback (1 year or so) compared with oversized rooftop units that cannot be operated effectively with the necessary high outdoor air percentages.« less

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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

H. Nolen, S. Maxwell, R. Neri, J. Grab

This research effort sought to achieve a solution package that yields energy savings greater than 30 percent over the pre-existing conditions in a minimally intrusive multifamily retrofit project. The Consortium for Advanced Residential Buildings (CARB) partnered with L+M Development Partners, Inc. on a Mitchell-Lama Housing Program project, Marcus Garvey Village, in Brooklyn, NY (Climate Zone 4A). The Mitchell-Lama Housing Program is a form of housing subsidy in the state of New York that provides affordable rental and cooperative housing to moderate- and middle-income families. Marcus Garvey Village was founded in 1975 and contains 625 residential units (ranging from studios tomore » 5-bedroom units) in thirty-two 4-story garden-style apartment structures built with concrete and faced in light brown brick. The single largest challenge for implementation of energy conservation measures at Marcus Garvey was working within occupied spaces. Measures are being implemented in phases to minimize disruption. As of August 2015, the retrofit work is over 50 percent complete. The wall insulation, sealing of the through wall AC vent, and installation of new oil-filled electric baseboards with advanced controls are conducted at one time, limiting disruption to the living room space. In a similar fashion, the kitchen work is done, then the bathroom. The final selection of energy conservation measures is projected to save 26.5 percent in source energy with a cost just under $3.7 million and utility bill savings of nearly $480,000 (of an average $1.8 million annual utility cost for the development).« less

Study and Implementation of White Power-LED Based Indoor Lighting Application for the Healthcare Sector

NASA Astrophysics Data System (ADS)

Chakraborty, A.; Ganguly, R.

With the current technological growth in the field of device fabrication, white power-LED's are available for solid state lighting applications. This is a paradigm shift from electrical lighting to electronic lighting. The implemented systems are showing some promise by saving a considerable amount of energy as well as providing a good and acceptable illumination level. However, the `useful life' of such devices is an important parameter. If the proper device is not chosen, the desired reliability and performance will not be obtained. In the present work, different parameters associated with reliability of such LED's are studied. Four different varieties of LED's are put to test the `useful life' as per IESNA LM 79 standard. From the results obtained, the proper LED is chosen for further application. Subsequently, lighting design is done for a hospital waiting room (indoor application) with 24 × 7 lighting requirements for replacement of existing CFLs there. The calculations show that although the initial cost is higher for LED based lighting, yet the savings on energy and replacement of the lamp results in a payback time of less than a year.

Intraoperative computed tomography guided neuronavigation: concepts, efficiency, and work flow.

PubMed

Matula, C; Rössler, K; Reddy, M; Schindler, E; Koos, W T

1998-01-01

Image-guided surgery is currently considered to be of undisputed value in microsurgical and endoscopical neurosurgery, but one of its major drawbacks is the degradation of accuracy during frameless stereotactic neuronavigation due to brain and/or lesion shift. A computed tomography (CT) scanner system (Philips Tomoscan M) developed for the operating room was connected to a pointer device navigation system for image-guided surgery (Philips EasyGuide system) in order to provide an integrated solution to this problem, and the advantages of this combination were evaluated in 20 cases (15 microsurgical and 5 endoscopic). The integration of the scanner into the operating room setup was successful in all procedures. The patients were positioned on a specially developed scanner table, which permitted movement to a scanning position then back to the operating position at any time during surgery. Contrast-enhanced preoperative CCTs performed following positioning and draping were of high quality in all cases, because a radiolucent head fixation technique was used. The accuracy achieved with this combination was significantly better (1.6:1.22.2). The overall concept is one of working in a closed system where everything is done in the same room, and the efficiency of this is clearly proven in different ways. The most important fact is the time saved in the overall treatment process (about 55 h for one operating room over a 6-month period). The combination of an intraoperative CCT scanner with the pointer device neuronavigation system permits not only the intraoperative control of resection of brain tumors, but also (in about 20% of cases) the identification of otherwise invisible residual tumor tissue by intraoperative update of the neuronavigation data set. Additionally, an image update solves the problem of intraoperative brain and/or tumor shifts during image-guided resection. Having the option of making an intraoperative quality check at any time leads to significantly increased efficiency, improves the operating work flow because of the closed-system concept, and offers an integrated solution for improved patient work flow and clinical outcome.

Finding New Space in Old Places: Repurposing Auxiliary Gyms

ERIC Educational Resources Information Center

Havens, Kevin

2010-01-01

Some parts of a school building do not age gracefully. At many elementary and middle schools--particularly those built in the 1960s or 1970s--old gyms are as useful (and attractive) as a worn-out pair of sneakers. To save money 20 years ago, school districts often used one space as a combination gym/lunch room/auditorium. Old gymnasiums offer…

Computer-Aided Surgical Simulation in Head and Neck Reconstruction: A Cost Comparison among Traditional, In-House, and Commercial Options.

PubMed

Li, Sean S; Copeland-Halperin, Libby R; Kaminsky, Alexander J; Li, Jihui; Lodhi, Fahad K; Miraliakbari, Reza

2018-06-01

 Computer-aided surgical simulation (CASS) has redefined surgery, improved precision and reduced the reliance on intraoperative trial-and-error manipulations. CASS is provided by third-party services; however, it may be cost-effective for some hospitals to develop in-house programs. This study provides the first cost analysis comparison among traditional (no CASS), commercial CASS, and in-house CASS for head and neck reconstruction.  The costs of three-dimensional (3D) pre-operative planning for mandibular and maxillary reconstructions were obtained from an in-house CASS program at our large tertiary care hospital in Northern Virginia, as well as a commercial provider (Synthes, Paoli, PA). A cost comparison was performed among these modalities and extrapolated in-house CASS costs were derived. The calculations were based on estimated CASS use with cost structures similar to our institution and sunk costs were amortized over 10 years.  Average operating room time was estimated at 10 hours, with an average of 2 hours saved with CASS. The hourly cost to the hospital for the operating room (including anesthesia and other ancillary costs) was estimated at $4,614/hour. Per case, traditional cases were $46,140, commercial CASS cases were $40,951, and in-house CASS cases were $38,212. Annual in-house CASS costs were $39,590.  CASS reduced operating room time, likely due to improved efficiency and accuracy. Our data demonstrate that hospitals with similar cost structure as ours, performing greater than 27 cases of 3D head and neck reconstructions per year can see a financial benefit from developing an in-house CASS program. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Radiofrequency-Based Identification Medical Device: An Evaluable Solution for Surgical Sponge Retrieval?

PubMed

Lazzaro, Alessandra; Corona, Arianna; Iezzi, Luca; Quaresima, Silvia; Armisi, Luca; Piccolo, Ilaria; Medaglia, Carlo Maria; Sbrenni, Sergio; Sileri, Pierpaolo; Rosato, Nicola; Gaspari, Achille Lucio; Di Lorenzo, Nicola

2017-06-01

A retained surgical item in patients (gossypiboma) is a persisting problem, despite consistent improvements and existing guidelines in counting instruments and sponges. Previous experiences with radiofrequency identification technology (RFID) tracking sponges show that it could represent an innovation, in order to reduce the criticism and increase the effectiveness during surgical procedures. We present an automated system that allows reduction of errors and improves safety in the operating room. The system consists of 3 antennas, surgical sponges containing RFID tags, and dedicated software applications, with Wi-Fi real-time communication between devices. The first antenna provides the initial count of gauzes; the second a real-time counting during surgery, including the sponges thrown into the kick-bucket; and the third can be used in the event of uneven sponge count. The software allows management at all stages of the process. In vitro and in vivo tests were performed: the system provided excellent results in detecting sponges in patients' body. Hundred percent retained sponges were detected correctly, even when they were overlapped. No false positive or false negative was recorded. The counting procedure turned out to be more streamlined and efficient and it could save time in a standard procedure. The RFID system for sponge tracking was shown to be experimentally a reliable and feasible method to track sponges with a full detection accuracy in the operating room. The results indicate the system to be safe and effective with acceptable cost-effective parameters.

Elimination of Routine Contact Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: A Retrospective Quasi-Experimental Study.

PubMed

Martin, Elise M; Russell, Dana; Rubin, Zachary; Humphries, Romney; Grogan, Tristan R; Elashoff, David; Uslan, Daniel Z

2016-11-01

OBJECTIVE To evaluate the impact of discontinuation of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) and expansion of chlorhexidine gluconate (CHG) use on the health system. DESIGN Retrospective, nonrandomized, observational, quasi-experimental study. SETTING Two California hospitals. PARTICIPANTS Inpatients. METHODS We compared hospital-wide laboratory-identified clinical culture rates (as a marker of healthcare-associated infections) 1 year before and after routine CP for endemic MRSA and VRE were discontinued and CHG bathing was expanded to all units. Culture data from patients and cost data on material utilization were collected. Nursing time spent donning personal protective equipment was assessed and quantified using time-driven activity-based costing. RESULTS Average positive culture rates before and after discontinuing CP were 0.40 and 0.32 cultures/100 admissions for MRSA (P=.09), and 0.48 and 0.40 cultures/100 admissions for VRE (P=.14). When combining isolation gown and CHG costs, the health system saved $643,776 in 1 year. Before the change, 28.5% intensive care unit and 19% medicine/surgery beds were on CP for MRSA/VRE. On the basis of average room entries and donning time, estimated nursing time spent donning personal protective equipment for MRSA/VRE before the change was 45,277 hours/year (estimated cost, $4.6 million). CONCLUSION Discontinuing routine CP for endemic MRSA and VRE did not result in increased rates of MRSA or VRE after 1 year. With cost savings on materials, decreased healthcare worker time, and no concomitant increase in possible infections, elimination of routine CP may add substantial value to inpatient care delivery. Infect Control Hosp Epidemiol 2016;1-8.

Incubation at room temperature may be an independent factor that induces chlamydospore production in Candida dubliniensis.

PubMed

Sancak, Banu; Colakoglu, Sule; Acikgoz, Ziya Cibali; Arikan, Sevtap

2005-08-01

Production of chlamydospores is one of the phenotypic features used to differentiate Candida albicans and Candida dubliniensis. C. albicans produces few chlamydospores on only cornmeal/rice-Tween agar at room temperature, whereas C. dubliniensis produces abundant chlamydospores at this temperature both on cornmeal agar and some other commonly used media. We tried to determine whether the room temperature is the main factor that induces chlamydospore production of C. dubliniensis, regardless of the medium used. For this purpose, 100 C. albicans and 24 C. dubliniensis isolates were tested for chlamydospore production at room temperature and at 37 degrees C on some routinely used media, including eosin-methylene blue agar (EMB), nutrient agar (NA), nutrient broth (NB), and also on an investigational medium, phenol red agar (PR). At 37 degrees C, none of the isolates produced chlamydospores on any of the tested media. At 26 degrees C, all C. dubliniensis isolates produced abundant chlamydospores and pseudohyphae after 24-48 h on all tested media. At this incubation temperature, all C. albicans isolates failed to produce chlamydospores and pseudohyphae on EMB, NA, and NB, whereas 2 of the C. albicans isolates produced a few chlamydospores on PR. We also observed that all C. dubliniensis isolates tested on EMB and PR produced rough colonies with a hyphal fringe around the colonies, whereas none of the C. albicans isolates showed this property. In conclusion, incubation at 26 degrees C may play the key role for production of abundant chlamydospores and pseudohyphae by C. dubliniensis. Comprehensive molecular studies are needed to clarify the genetic basis of this observation. Using EMB and PR may be an inexpensive, a time-saving, and a simple way of presumptive identification of C. dubliniensis based on chlamydospore formation and colony morphology.

Algorithm of dynamic regulation of a system of duct, for a high accuracy climatic system

NASA Astrophysics Data System (ADS)

Arbatskiy, A. A.; Afonina, G. N.; Glazov, V. S.

2017-11-01

Currently, major part of climatic system, are stationary in projected mode only. At the same time, many modern industrial sites, require constant or periodical changes in technological process. That is 80% of the time, the industrial site is not require ventilation system in projected mode and high precision of climatic parameters must maintain. While that not constantly is in use for climatic systems, which use in parallel for different rooms, we will be have a problem for balance of duct system. For this problem, was created the algorithm for quantity regulation, with minimal changes. Dynamic duct system: Developed of parallel control system of air balance, with high precision of climatic parameters. The Algorithm provide a permanent pressure in main duct, in different a flow of air. Therefore, the ending devises air flow have only one parameter for regulation - flaps open area. Precision of regulation increase and the climatic system provide high precision for temperature and humidity (0,5C for temperature, 5% for relative humidity). Result: The research has been made in CFD-system - PHOENICS. Results for velocity of air in duct, for pressure of air in duct for different operation mode, has been obtained. Equation for air valves positions, with different parameters for climate in room’s, has been obtained. Energy saving potential for dynamic duct system, for different types of a rooms, has been calculated.

Thoracic robotics at the Heart Hospital Baylor Plano: the first 20 cases

PubMed Central

2012-01-01

A da Vinci Robotic Surgical System was purchased for The Heart Hospital Baylor Plano in fall 2011 and a program for robotic-assisted thoracic surgery commenced at the facility. Successive thoracic patients were offered and accepted a robotic-assisted operation. No patient was excluded because of age, height, weight, or comorbidities. The first 20 patients are summarized herein. Of the first 10 operations, only one was a lobectomy. As the program staff gained experience, seven of the latter 10 procedures were lobectomies. The average length of stay was 2.6 days (longest, 4 days). The average operating room time was 147 minutes overall and 200 minutes for lobectomies. The longest operating room time was 337 minutes in a patient who underwent a right middle lobectomy that was converted to a video-assisted thoracic surgery. Two patients developed atrial fibrillation, one of whom had a pacemaker and a history of paroxysmal atrial fibrillation. One patient developed a bronchopleural fistula on the first postoperative day, following a coughing episode. One patient was readmitted 6 days after hospital discharge with a pneumothorax, which was successfully treated with a small-bore catheter. In conclusion, robotic-assisted thoracic surgery has many advantages. Decreased complications can lead to improved outcomes, and hospitals can achieve cost savings as a result of reduced length of stay. PMID:23077378

Retrofitting solutions for two different occupancy levels of educational buildings in tropics

NASA Astrophysics Data System (ADS)

Yang, Junjing; Pantazaras, Alexandros; Lee, Siew Eang; Santamouris, Mattheos

2018-01-01

Within the multi-functionality of educational buildings, the energy conservation potential can be very different. In addition, among different retrofitting solutions investigated involving interventions on the building envelope, ventilation strategies, artificial lighting systems as well as equipment upgrading, different saving potential would come from different aspects. The opportunities for energy saving potential from the overall point of view and from the detailed aspect view of different retrofitting solutions would be very useful and important for building renovation decision making. This study presents a detailed retrofitting study of two different educational buildings. One represents a building with average occupancy variation and containing mainly offices and labs. The other one represents a building with high occupancy variation and containing mainly lecture rooms and studios. This comparison of the results gives an idea of the different energy saving potential for different types of educational buildings. Principal component analysis is also adopted to investigate the detailed performance of one of the buildings which is influenced stronger by these retrofitting solutions.

Downlight Demonstration Program: Hilton Columbus Downtown

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

Davis, Robert G.; Perrin, Tess E.

2014-05-13

The U.S. Department of Energy (DOE) estimates that there were about 700 million downlight luminaires installed in residential and commercial buildings in the U.S. as of 2012, with light-emitting diode (LED) luminaires representing less than 1% of this installed base. Downlight luminaires using conventional incandescent, halogen, and compact fluorescent lamps have lower efficacies and shorter expected lifetimes than comparable LED systems, but the lower initial cost of the conventional technology and the uncertainties associated with the newer LED technology have restricted widespread adoption of LED downlight luminaires. About 278 tBtu of energy could be saved annually if LED luminaires weremore » to saturate the downlight market, equating to an annual energy cost savings of $2.6 billion. This report summarizes an evaluation of LED recessed downlight luminaires in the guest rooms at the Hilton Columbus Downtown hotel in Columbus, OH. The facility opened in October of 2012, and the U.S. Department of Energy (DOE) conducted a post-occupancy assessment of the facility in January–March of 2014. Each of the 484 guest rooms uses seven 15 W LED downlights: four downlights in the entry and bedroom and three downlights in the bathroom. The 48 suites use the seven 15 W LED downlights and additional fixtures depending on the space requirements, so that in total the facility has more than 3,700 LED downlights. The downlights are controlled through wall-mounted switches and dimmers. A ceiling-mounted vacancy sensor ensures that the bathroom luminaires are turned off when the room is not occupied.« less

Extracorporeal cardiopulmonary resuscitation for blunt cardiac rupture.

PubMed

Kudo, Shunsuke; Tanaka, Keiji; Okada, Kunihiko; Takemura, Takahiro

2017-11-01

Extracorporeal cardiopulmonary resuscitation (ECPR) followed by operating room sternotomy, rather than resuscitative thoracotomy, might be life-saving for patients with blunt cardiac rupture and cardiac arrest who do not have multiple severe traumatic injuries. A 49-year-old man was injured in a vehicle crash and transferred to the emergency department. On admission, he was hemodynamically stable, but a plain chest radiograph revealed a widened mediastinum, and echocardiography revealed hemopericardium. A computed tomography scan revealed hemopericardium and mediastinal hematoma, without other severe traumatic injuries. However, the patient's pulse was lost soon after he was transferred to the intensive care unit, and cardiopulmonary resuscitation was initiated. We initiated ECPR using femorofemoral veno-arterial extracorporeal membrane oxygenation (ECMO) with heparin administration, which achieved hemodynamic stability. He was transferred to the operating room for sternotomy and cardiac repair. Right ventricular rupture and pericardial sac laceration were identified intraoperatively, and cardiac repair was performed. After repairing the cardiac rupture, the cardiac output recovered spontaneously, and ECMO was discontinued intraoperatively. The patient recovered fully and was discharged from the hospital on postoperative day 7. In this patient, ECPR rapidly restored brain perfusion and provided enough time to perform operating room sternotomy, allowing for good surgical exposure of the heart. Moreover, open cardiac massage was unnecessary. ECPR with sternotomy and cardiac repair is advisable for patients with blunt cardiac rupture and cardiac arrest who do not have severe multiple traumatic injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

Healthcare cost savings estimator tool for chronic disease self-management program: a new tool for program administrators and decision makers.

PubMed

Ahn, SangNam; Smith, Matthew Lee; Altpeter, Mary; Post, Lindsey; Ory, Marcia G

2015-01-01

Chronic disease self-management education (CDSME) programs have been delivered to more than 100,000 older Americans with chronic conditions. As one of the Stanford suite of evidence-based CDSME programs, the chronic disease self-management program (CDSMP) has been disseminated in diverse populations and settings. The objective of this paper is to introduce a practical, universally applicable tool to assist program administrators and decision makers plan implementation efforts and make the case for continued program delivery. This tool was developed utilizing data from a recent National Study of CDSMP to estimate national savings associated with program participation. Potential annual healthcare savings per CDSMP participant were calculated based on averted emergency room visits and hospitalizations. While national data can be utilized to estimate cost savings, the tool has built-in features allowing users to tailor calculations based on their site-specific data. Building upon the National Study of CDSMP's documented potential savings of $3.3 billion in healthcare costs by reaching 5% of adults with one or more chronic conditions, two heuristic case examples were also explored based on different population projections. The case examples show how a small county and large metropolitan city were not only able to estimate healthcare savings ($38,803 for the small county; $732,290 for the large metropolitan city) for their existing participant populations but also to project significant healthcare savings if they plan to reach higher proportions of middle-aged and older adults. Having a tool to demonstrate the monetary value of CDSMP can contribute to the ongoing dissemination and sustainability of such community-based interventions. Next steps will be creating a user-friendly, internet-based version of Healthcare Cost Savings Estimator Tool: CDSMP, followed by broadening the tool to consider cost savings for other evidence-based programs.

Valuation of travel time savings in viewpoint of WTA.

PubMed

Shao, Chang-Qiao; Liu, Yang; Liu, Xiao-Ming

2014-01-01

In order to investigate the issues in measurement of value of travel time savings (VTTS), the willingness-to-accept (WTA) for the private car owner is studied by using surveyed data. It is convincing that trip purpose, trip length, time savings, cost savings, income, and allowance from employee have effects on the WTA. Moreover, influences of these variables are not the same for different trip purposes. For commuting trips, effects of income and allowance from employee are significant while time savings and cost savings are dominated for leisure and shopping trips. It is also found that WTA is much higher than expected which implies that there are a group of drivers who are not prone to switching to other trip modes other than passenger car.

Retrofitting Garden-Style Apartments in Brooklyn, New York

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

Nolen, Heather; Maxwell, Sean; Neri, Robin

This research effort sought to achieve a solution package that yields energy savings greater than 30% over the pre-existing conditions in a minimally intrusive multifamily retrofit project. The Consortium for Advanced Residential Buildings (CARB) partnered with L+M Development Partners, Inc. on a Mitchell-Lama Housing Program project, Marcus Garvey Village, in Brooklyn, NY (Climate Zone 4A). The Mitchell-Lama Housing Program is a form of housing subsidy in the state of New York that provides affordable rental and cooperative housing to moderate- and middle-income families. Marcus Garvey Village was founded in 1975 and contains 625 residential units (ranging from studios to 5-bedroommore » units) in thirty-two 4-story garden-style apartment structures built with concrete and faced in light brown brick. The single largest challenge for implementation of energy conservation measures at Marcus Garvey was working within occupied spaces. Measures are being implemented in phases to minimize disruption. As of August 2015, the retrofit work is over 50% complete. The wall insulation, sealing of the through wall AC vent, and installation of new oil-filled electric baseboards with advanced controls are conducted at one time, limiting disruption to the living room space. In a similar fashion, the kitchen work is done, then the bathroom. The final selection of energy conservation measures is projected to save 26.5% in source energy with a cost just under $3.7 million and utility bill savings of nearly $480,000 (of an average $1.8 million annual utility cost for the development).« less

Building America Case Study: Retrofitting Garden-Style Apartments, Brooklyn, New York

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

This research effort sought to achieve a solution package that yields energy savings greater than 30 percent over the pre-existing conditions in a minimally intrusive multifamily retrofit project. The Consortium for Advanced Residential Buildings (CARB) partnered with L+M Development Partners, Inc. on a Mitchell-Lama Housing Program project, Marcus Garvey Village, in Brooklyn, NY (Climate Zone 4A). The Mitchell-Lama Housing Program is a form of housing subsidy in the state of New York that provides affordable rental and cooperative housing to moderate- and middle-income families. Marcus Garvey Village was founded in 1975 and contains 625 residential units (ranging from studios tomore » 5-bedroom units) in thirty-two 4-story garden-style apartment structures built with concrete and faced in light brown brick. The single largest challenge for implementation of energy conservation measures at Marcus Garvey was working within occupied spaces. Measures are being implemented in phases to minimize disruption. As of August 2015, the retrofit work is over 50 percent complete. The wall insulation, sealing of the through wall AC vent, and installation of new oil-filled electric baseboards with advanced controls are conducted at one time, limiting disruption to the living room space. In a similar fashion, the kitchen work is done, then the bathroom. The final selection of energy conservation measures is projected to save 26.5 percent in source energy with a cost just under $3.7 million and utility bill savings of nearly $480,000 (of an average $1.8 million annual utility cost for the development).« less

17 CFR 232.13 - Date of filing; adjustment of filing date.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Standard Time or Eastern Daylight Saving Time, whichever is currently in effect, shall be deemed filed on.... Eastern Standard Time or Eastern Daylight Saving Time, whichever is currently in effect, shall be deemed... Daylight Savings Time, whichever is currently in effect, shall be deemed filed on the same business day. (4...

17 CFR 232.13 - Date of filing; adjustment of filing date.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Standard Time or Eastern Daylight Saving Time, whichever is currently in effect, shall be deemed filed on.... Eastern Standard Time or Eastern Daylight Saving Time, whichever is currently in effect, shall be deemed... Daylight Savings Time, whichever is currently in effect, shall be deemed filed on the same business day. (4...

17 CFR 232.13 - Date of filing; adjustment of filing date.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Standard Time or Eastern Daylight Saving Time, whichever is currently in effect, shall be deemed filed on.... Eastern Standard Time or Eastern Daylight Saving Time, whichever is currently in effect, shall be deemed... Daylight Savings Time, whichever is currently in effect, shall be deemed filed on the same business day. (4...

17 CFR 232.13 - Date of filing; adjustment of filing date.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Standard Time or Eastern Daylight Saving Time, whichever is currently in effect, shall be deemed filed on.... Eastern Standard Time or Eastern Daylight Saving Time, whichever is currently in effect, shall be deemed... Daylight Savings Time, whichever is currently in effect, shall be deemed filed on the same business day. (4...

Cost-consequence analysis of multimodal interventions with environmental components for pediatric asthma in the state of Maryland.

PubMed

Jassal, Mandeep S; Diette, Gregory B; Dowdy, David W

2013-08-01

Applied environmental strategies for asthma control are often expensive, but may save longer-term healthcare costs. Whether these savings outweigh additional costs of implementing these strategies is uncertain. We conducted a systematic review to estimate the expenditures and savings of environmental interventions for asthma in the state of Maryland. Direct costs included hospitalizations, emergency room, and clinic visits. Indirect expenditures included costs of lost work productivity and travel incurred during the usage of healthcare services. We used decision analysis, assuming a hypothetical cohort of the approximated 49,290 pediatric individuals in Maryland with persistent asthma, to compare costs and benefits of environmental asthma interventions against the standard of care (no intervention) from the societal perspective. Three interventions among nine articles met the inclusion criteria for the systematic review: 1) environmental education using medical professionals; 2) education using non-medical personnel; and 3) multi-component strategy involving education with non-medical personnel, allergen-impermeable covers, and pest management. All interventions were found to be cost-saving relative to the standard of care. Home environmental education using non-medical professionals yielded the highest net savings of $14.1 million (95% simulation interval (SI): $-.283 million, $19.4 million), while the multi-component intervention resulted in the lowest net savings of $8.1 million (95% SI: $-4.9 million, $15.9 million). All strategies were most sensitive to the baseline number of hospitalizations in those not receiving targeted interventions for asthma. Limited environmental reduction strategies for asthma are likely to be cost-saving to the healthcare system in Maryland and should be considered for broader scale-up in other economically similar settings.

Energy Efficiency in Small Server Rooms: Field Surveys and Findings

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

Cheung, Iris; Greenberg, Steve; Mahdavi, Roozbeh

Fifty-seven percent of US servers are housed in server closets, server rooms, and localized data centers, in what are commonly referred to as small server rooms, which comprise 99percent of all server spaces in the US. While many mid-tier and enterprise-class data centers are owned by large corporations that consider energy efficiency a goal to minimize business operating costs, small server rooms typically are not similarly motivated. They are characterized by decentralized ownership and management and come in many configurations, which creates a unique set of efficiency challenges. To develop energy efficiency strategies for these spaces, we surveyed 30 smallmore » server rooms across eight institutions, and selected four of them for detailed assessments. The four rooms had Power Usage Effectiveness (PUE) values ranging from 1.5 to 2.1. Energy saving opportunities ranged from no- to low-cost measures such as raising cooling set points and better airflow management, to more involved but cost-effective measures including server consolidation and virtualization, and dedicated cooling with economizers. We found that inefficiencies mainly resulted from organizational rather than technical issues. Because of the inherent space and resource limitations, the most effective measure is to operate servers through energy-efficient cloud-based services or well-managed larger data centers, rather than server rooms. Backup power requirement, and IT and cooling efficiency should be evaluated to minimize energy waste in the server space. Utility programs are instrumental in raising awareness and spreading technical knowledge on server operation, and the implementation of energy efficiency measures in small server rooms.« less

Accelerated Testing Methodology for the Determination of Slow Crack Growth of Advanced Ceramics

NASA Technical Reports Server (NTRS)

Choi, Sung R.; Salem, Jonathan A.; Gyekenyesi, John P.

1997-01-01

Constant stress-rate (dynamic fatigue) testing has been used for several decades to characterize slow crack growth behavior of glass and ceramics at both ambient and elevated temperatures. The advantage of constant stress-rate testing over other methods lies in its simplicity: Strengths are measured in a routine manner at four or more stress rates by applying a constant crosshead speed or constant loading rate. The slow crack growth parameters (n and A) required for design can be estimated from a relationship between strength and stress rate. With the proper use of preloading in constant stress-rate testing, an appreciable saving of test time can be achieved. If a preload corresponding to 50 % of the strength is applied to the specimen prior to testing, 50 % of the test time can be saved as long as the strength remains unchanged regardless of the applied preload. In fact, it has been a common, empirical practice in strength testing of ceramics or optical fibers to apply some preloading (less then 40%). The purpose of this work is to study the effect of preloading on the strength to lay a theoretical foundation on such an empirical practice. For this purpose, analytical and numerical solutions of strength as a function of preloading were developed. To verify the solution, constant stress-rate testing using glass and alumina at room temperature and alumina silicon nitride, and silicon carbide at elevated temperatures was conducted in a range of preloadings from O to 90 %.

Control Technologies for Room Air-conditioner and Packaged Air-conditioner

NASA Astrophysics Data System (ADS)

Ito, Nobuhisa

Trends of control technologies about air-conditioning machineries, especially room or packaged air conditioners, are presented in this paper. Multiple air conditioning systems for office buildings are mainly described as one application of the refrigeration cycle control technologies including sensors for thermal comfort and heating/ cooling loads are also described as one of the system control technologies. Inverter systems and related technologies for driving variable speed compressors are described in both case of including induction motors and brushless DC motors. Technologies for more accurate control to meet various kind of regulations such as ozone layer destruction, energy saving and global warming, and for eliminating harmonic distortion of power source current, as a typical EMC problem, will be urgently desired.

Dense Tracking and Mapping with a Quadrocopter

NASA Astrophysics Data System (ADS)

Sturm, J.; Bylow, E.; Kerl, C.; Kahl, F.; Cremers, D.

2013-08-01

In this paper, we present an approach for acquiring textured 3D models of room-sized indoor spaces using a quadrocopter. Such room models are for example useful for architects and interior designers as well as for factory planners and construction managers. The model is internally represented by a signed distance function (SDF) and the SDF is used to directly track the camera with respect to the model. Our solution enables accurate position control of the quadrocopter, so that it can automatically follow a pre-defined flight pattern. Our system provides live feedback of the acquired 3D model to the user. The final model consisting of a textured 3D triangle mesh can be saved in several standard CAD file formats.

Improving efficiency and value in health care. Intravenous iron management for anaemia associated with chronic kidney disease: linking treatment to an outpatient clinic, optimizing service provision and patient choice.

PubMed

Bhandari, Sunil; Naudeer, Sarah

2008-12-01

The National Service Framework advocates correction of anaemia in patients with chronic kidney disease (CKD). Oral iron is insufficient, while intravenous (IV) supplementation replenishes and maintains iron stores. In Yorkshire numerous peripheral clinics exist to reduce travel for patients, but patients must travel to the main unit for IV iron therapy. Therefore an outpatient service in tandem with a routine clinic for administration of IV CosmoFer was created. To evaluate the feasibility and benefits of IV iron therapy in the outpatient clinic during active patient review for CKD patients. A cross-sectional study of patients attending for total dose IV iron (n = 57) at a peripheral clinic. Iron was administered and monitored according to protocol by one of the clinic nurses with medical staff available in the adjoining room. Haemoglobin, ferritin and renal function were recorded pre-infusion and after 4-6 months. Results are given as medians/means +/- standard error. A total of 76 IV infusions were carried out with no reported side effects or haemodynamic instability. Haemoglobin (median 10.9 vs. 11.3 g dL(-1), P = NS), creatinine and estimated glomerular filtration rate (eGFR) over the 6-month period remained stable. Serum ferritin rose significantly [80.9 +/- 6.2 vs. 186.4 +/- 18.2 g L(-1) (P < 0.001)]. Hospital time saved 380 day case bed hours, doctor hours saved 76 hours, and patient hours saved 3 hours/patient. Cost savings for TDI CosmoFer in peripheral clinic versus in centre therapy and versus sucrose, respectively, for 76 treatments was pound 5749.40 and pound 46,320.80 respectively. We have demonstrated, in a resource-limited service, the feasibility and cost-effectiveness of a management care pathway for patients with CKD, in a peripheral clinic, to receive total dose IV CosmoFer without disruption of a functioning renal clinic.

Computer Labs Get Rebooted as Lounges: New Gathering Places for Laptop Users Help Colleges Save on Upkeep

ERIC Educational Resources Information Center

Terris, Ben

2010-01-01

Colleges are looking for ways to cut costs, and most students now own laptops. As a result, many campus technology leaders are taking a hard look at those brightly lit rooms with rows of networked computers, which cost hundreds of thousands of dollars a year to maintain. More than 11% of colleges and universities are phasing out computer labs or…

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

PubMed

Castellet, Lledó; Molinos-Senante, María

2016-02-01

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

Six Sigma in healthcare delivery.

PubMed

Liberatore, Matthew J

2013-01-01

The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

Year-Round Daylight Saving Time Study : Volume 1. Interim Report on the Operation and Effects of Daylight Saving Time

DOT National Transportation Integrated Search

1975-06-01

The analyses of the effects of Year-Round Daylight Saving Time were not conslusive because they could not be reliablyseparated from other changes occuring simultaneously including fuel availability constraints, speed limit reductions, Sunday gasoline...

NASA IVHM Technology Experiment for X-vehicles (NITEX)

NASA Technical Reports Server (NTRS)

Sandra, Hayden; Bajwa, Anupa

2001-01-01

The purpose of the NASA IVHM Technology Experiment for X-vehicles (NITEX) is to advance the development of selected IVHM technologies in a flight environment and to demonstrate the potential for reusable launch vehicle ground processing savings. The technologies to be developed and demonstrated include system-level and detailed diagnostics for real-time fault detection and isolation, prognostics for fault prediction, automated maintenance planning based on diagnostic and prognostic results, and a microelectronics hardware platform. Complete flight The Evolution of Flexible Insulation as IVHM consists of advanced sensors, distributed data acquisition, data processing that includes model-based diagnostics, prognostics and vehicle autonomy for control or suggested action, and advanced data storage. Complete ground IVHM consists of evolved control room architectures, advanced applications including automated maintenance planning and automated ground support equipment. This experiment will advance the development of a subset of complete IVHM.

Germanium resistance thermometer calibration at superfluid helium temperatures

NASA Technical Reports Server (NTRS)

Mason, F. C.

1985-01-01

The rapid increase in resistance of high purity semi-conducting germanium with decreasing temperature in the superfluid helium range of temperatures makes this material highly adaptable as a very sensitive thermometer. Also, a germanium thermometer exhibits a highly reproducible resistance versus temperature characteristic curve upon cycling between liquid helium temperatures and room temperature. These two factors combine to make germanium thermometers ideally suited for measuring temperatures in many cryogenic studies at superfluid helium temperatures. One disadvantage, however, is the relatively high cost of calibrated germanium thermometers. In space helium cryogenic systems, many such thermometers are often required, leading to a high cost for calibrated thermometers. The construction of a thermometer calibration cryostat and probe which will allow for calibrating six germanium thermometers at one time, thus effecting substantial savings in the purchase of thermometers is considered.

Los Alamos Plutonium Facility Waste Management System

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

Smith, K.; Montoya, A.; Wieneke, R.

1997-02-01

This paper describes the new computer-based transuranic (TRU) Waste Management System (WMS) being implemented at the Plutonium Facility at Los Alamos National Laboratory (LANL). The Waste Management System is a distributed computer processing system stored in a Sybase database and accessed by a graphical user interface (GUI) written in Omnis7. It resides on the local area network at the Plutonium Facility and is accessible by authorized TRU waste originators, count room personnel, radiation protection technicians (RPTs), quality assurance personnel, and waste management personnel for data input and verification. Future goals include bringing outside groups like the LANL Waste Management Facilitymore » on-line to participate in this streamlined system. The WMS is changing the TRU paper trail into a computer trail, saving time and eliminating errors and inconsistencies in the process.« less

Cost-utility analysis of the housing and health intervention for homeless and unstably housed persons living with HIV.

PubMed

Holtgrave, David R; Wolitski, Richard J; Pals, Sherri L; Aidala, Angela; Kidder, Daniel P; Vos, David; Royal, Scott; Iruka, Nkemdiri; Briddell, Kate; Stall, Ron; Bendixen, Arturo Valdivia

2013-06-01

We present a cost-utility analysis based on data from the Housing and Health (H&H) Study of rental assistance for homeless and unstably housed persons living with HIV in Baltimore, Chicago and Los Angeles. As-treated analyses found favorable associations of housing with HIV viral load, emergency room use, and perceived stress (an outcome that can be quantitatively linked to quality of life). We combined these outcome data with information on intervention costs to estimate the cost-per-quality-adjusted-life-year (QALY) saved. We estimate that the cost-per-QALY-saved by the HIV-related housing services is $62,493. These services compare favorably (in terms of cost-effectiveness) to other well-accepted medical and public health services.

Office-based Management of Recurrent Respiratory Papilloma.

PubMed

Motz, Kevin M; Hillel, Alexander T

2016-06-01

This review will highlight the indications and benefits of office-based therapy for recurrent respiratory papillomatosis (RRP) and discuss the utilization of photo-dynamic lasers and adjuvant medical therapy in office-based settings. Office-based management of RRP allows for more timely interventions, is preferred by the majority of patients, and negates the risk of general anesthesia. Current literature argues for the utilization of KTP laser over CO 2 laser for office-based treatment of RRP. Medical therapies for RRP are limited, but agents such as bevacizumab are promising and have been shown to reduce disease burden. Medical therapies that can induce disease remission are still needed. Office-based procedures save time and healthcare expenses compared to like procedures in the operating room. However, the increased frequency for office-based procedures predicts similar overall healthcare costs for office-based and OR laser excision of RRP. Office-based management of RRP is a feasible and well-tolerated strategy in appropriately selected patients with adequate local anesthesia.

Chapter 10: Peak Demand and Time-Differentiated Energy Savings Cross-Cutting Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

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

Kurnik, Charles W; Stern, Frank; Spencer, Justin

Savings from electric energy efficiency measures and programs are often expressed in terms of annual energy and presented as kilowatt-hours per year (kWh/year). However, for a full assessment of the value of these savings, it is usually necessary to consider the measure or program's impact on peak demand as well as time-differentiated energy savings. This cross-cutting protocol describes methods for estimating the peak demand and time-differentiated energy impacts of measures implemented through energy efficiency programs.

Project Lateday : The Level of Accidents Under the Effect of Daylight Saving All Year

DOT National Transportation Integrated Search

1975-10-01

Year-round daylight saving time (YRDST) has recently been observed in the United States. The observance of double daylight saving time (DDST) is under some consideration. One of the principal expected effects of the adoption of these time systems is ...

Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies.

PubMed

Prada, Sergio I

2017-12-01

The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug-drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so. To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid retrospective DUR program in federal fiscal years 2014 and 2015. For each state, the cost-savings methodologies included in the Medicaid DUR 2014 and 2015 reports were downloaded from Medicaid's website. The reports were then reviewed and synthesized. Methods described by the states were classified according to research designs often described in evaluation textbooks. In 2014, the most often used prescription drugs cost-savings estimation methodology for the Medicaid retrospective DUR program was a simple pre-post intervention method, without a comparison group (ie, 12 states). In 2015, the most common methodology used was a pre-post intervention method, with a comparison group (ie, 14 states). Comparisons of savings attributed to the program among states are still unreliable, because of a lack of a common methodology available for measuring cost-savings. There is great variation among states in the methods used to measure prescription drug utilization cost-savings. This analysis suggests that there is still room for improvement in terms of methodology transparency, which is important, because lack of transparency hinders states from learning from each other. Ultimately, the federal government needs to evaluate and improve its DUR program.

Application of Multipurpose Cadastre to Evaluate Energy Security of Land Parcel (Case Study: Gedung A and Gedung B, Institut Teknologi Sumatra)

NASA Astrophysics Data System (ADS)

Alif, S. M.; Nugroho, A. P.; Leksono, B. E.

2018-03-01

Energy security has one of its dimensions: Short-term energy security which focuses on the ability of the energy system to react promptly to sudden changes within the supply-demand balance. Non-energy components (such as land parcel) that comprise an energy system are analysed comprehensively with other component to measure energy security related to energy supply. Multipurpose cadastre which is an integrated land information system containing legal, physical, and cultural is used to evaluate energy (electrical energy) security of land parcel. The fundamental component of multipurpose cadastre used to evaluate energy security is attribute data which is the value of land parcel facilities. Other fundamental components (geographic control data, base map data, cadastral data) are used as position information and provide weight in room (part of land parcel) valuation. High value-room means the room is comfortable and/or used productively by its occupant. The method of valuation is by comparing one facility to other facilities. Facilities included in room valuation are relatively static items (such as chair, desk, and cabinet) except lamps and other electronic devices. The room value and number of electronic devices which consume electrical energy are correlated with each other. Consumption of electrical energy of electronic devices in the room with average value remains constant while consumption in other room needs to be evaluated to save the energy. The result of this research shows that room value correlate weakly with number of electronic device in corresponding room. It shows excess energy consumed in low-value room. Although numbers of electronic devices do not always mean the consumption of electrical energy and there are plenty electronic devices, it is recommended for occupant to be careful in utilizing electronic devices in low-value room to minimize energy consumption.

[Newly developed monitor for IVR: liquid crystal display (LCD) replaced with cathode ray tube (CRT)].

PubMed

Ichida, Takao; Hosogai, Minoru; Yokoyama, Kouji; Ogawa, Takayoshi; Okusako, Kenji; Shougaki, Masachika; Masai, Hironao; Yamada, Eiji; Okuyama, Kazuo; Hatagawa, Masakatsu

2004-09-01

For physicians who monitor images during interventional radiology (VR), we have built and been using a system that employs a liquid crystal display (LCD) instead of the conventional cathode ray tube (CRT). The system incorporates a ceiling-suspension-type monitor (three-display monitor) with an LCD on each of the three displays for the head and abdominal regions and another ceiling-suspension-type monitor (5-display monitor) with an LCD on each display for the cardiac region. As these monitors are made to be thin and light in weight, they can be placed in a high position in the room, thereby saving space and allowing for more effective use of space in the X-ray room. The system has also improved the efficiency of operators in the IVR room. The three-display folding mechanism allows the displays to be viewed from multiple directions, thereby improving the environment so that the performance of IVR can be observed.

Estimated time of arrival and debiasing the time saving bias.

PubMed

Eriksson, Gabriella; Patten, Christopher J D; Svenson, Ola; Eriksson, Lars

2015-01-01

The time saving bias predicts that the time saved when increasing speed from a high speed is overestimated, and underestimated when increasing speed from a slow speed. In a questionnaire, time saving judgements were investigated when information of estimated time to arrival was provided. In an active driving task, an alternative meter indicating the inverted speed was used to debias judgements. The simulated task was to first drive a distance at a given speed, and then drive the same distance again at the speed the driver judged was required to gain exactly 3 min in travel time compared with the first drive. A control group performed the same task with a speedometer and saved less than the targeted 3 min when increasing speed from a high speed, and more than 3 min when increasing from a low speed. Participants in the alternative meter condition were closer to the target. The two studies corroborate a time saving bias and show that biased intuitive judgements can be debiased by displaying the inverted speed. Practitioner Summary: Previous studies have shown a cognitive bias in judgements of the time saved by increasing speed. This simulator study aims to improve driver judgements by introducing a speedometer indicating the inverted speed in active driving. The results show that the bias can be reduced by presenting the inverted speed and this finding can be used when designing in-car information systems.

Comparative cost analysis of housing and case management program for chronically ill homeless adults compared to usual care.

PubMed

Basu, Anirban; Kee, Romina; Buchanan, David; Sadowski, Laura S

2012-02-01

To assess the costs of a housing and case management program in a novel sample-homeless adults with chronic medical illnesses. The study used data from multiple sources: (1) electronic medical records for hospital, emergency room, and ambulatory medical and mental health visits; (2) institutional and regional databases for days in respite centers, jails, or prisons; and (3) interviews for days in nursing homes, shelters, substance abuse treatment centers, and case manager visits. Total costs were estimated using unit costs for each service. Randomized controlled trial of 407 homeless adults with chronic medical illnesses enrolled at two hospitals in Chicago, Illinois, and followed for 18 months. Compared to usual care, the intervention group generated an average annual cost savings of (-)$6,307 per person (95 percent CI: -16,616, 4,002; p = .23). Subgroup analyses of chronically homeless and those with HIV showed higher per person, annual cost savings of (-)$9,809 and (-)$6,622, respectively. Results were robust to sensitivity analysis using unit costs. The findings of this comprehensive, comparative cost analyses demonstrated an important average annual savings, though in this underpowered study these savings did not achieve statistical significance. © Health Research and Educational Trust.

Enhanced Thermal Performance of Mosques in Qatar

NASA Astrophysics Data System (ADS)

Touma, A. Al; Ouahrani, D.

2017-12-01

Qatar has an abundance of mosques that significantly contribute to the increasing energy consumption in the country. Little attention has been given to providing mitigation methods that limit the energy demands of mosques without violating the worshippers’ thermal comfort. Most of these researches dealt with enhancing the mosque envelope through the addition of insulation layers. Since most mosque walls in Qatar are mostly already insulated, this study proposes the installation of shading on the mosque roof that is anticipated to yield similar energy savings in comparison with insulated roofs. An actual mosque in Qatar, which is a combination of six different spaces consisting of men and women’s prayer rooms, ablutions and toilets, was simulated and yielded a total annual energy demand of 619.55 kWh/m2. The mosque, whose walls are already insulated, yielded 9.1% energy savings when an insulation layer was added to its roof whereas it produced 6.2% energy savings when a shading layer was added above this roof. As the reconstruction of the roof envelope is practically unrealistic in existing mosques, the addition of shading to the roof was found to produce comparable energy savings. Lastly, it was found that new mosques with thin-roof insulation and shading tend to be more energy-efficient than those with thick-roof insulation.

Effects of daylight savings time changes on stock market volatility.

PubMed

Berument, M Hakan; Dogan, Nukhet; Onar, Bahar

2010-04-01

The presence of daylight savings time effects on stock returns and on stock volatility was investigated using an EGARCH specification to model the conditional variance. The evidence gathered from the major United States stock markets for the period between 1967 and 2007 did not support the existence of the daylight savings time effect on stock returns or on volatility. Returns on the first business day following daylight savings time changes were not lower nor was the volatility higher, as would be expected if there were an effect.

Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center.

PubMed

Cima, Robert R; Brown, Michael J; Hebl, James R; Moore, Robin; Rogers, James C; Kollengode, Anantha; Amstutz, Gwendolyn J; Weisbrod, Cheryl A; Narr, Bradly J; Deschamps, Claude

2011-07-01

Operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency. A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process from the decision for surgery to discharge. Each process step was analyzed in 3 domains, ie, personnel, information processed, and time. Multidisciplinary teams addressed 5 work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation. Across 3 surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 pm. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day. Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of GeneXpert MTB/RIF assay on triage of respiratory isolation rooms for inpatients with presumed tuberculosis: a hypothetical trial.

PubMed

Chaisson, Lelia H; Roemer, Marguerite; Cantu, David; Haller, Barbara; Millman, Alexander J; Cattamanchi, Adithya; Davis, J Lucian

2014-11-15

Placing inpatients with presumed active pulmonary tuberculosis in respiratory isolation pending results of serial sputum acid-fast bacilli (AFB) smear microscopy is standard practice in high-income countries. However, this diagnostic strategy is slow and yields few tuberculosis diagnoses. We sought to determine if replacing microscopy with the GeneXpert MTB/RIF (Xpert) nucleic acid amplification assay could reduce testing time and usage of isolation rooms. We prospectively followed inpatients at San Francisco General Hospital undergoing tuberculosis evaluation. We performed smear microscopy and Xpert testing on concentrated sputum, and calculated diagnostic accuracy for both strategies in reference to serial sputum mycobacterial culture. We measured turnaround time for microscopy and estimated hypothetical turnaround times for Xpert on concentrated and unconcentrated sputum. We compared median and total isolation times for microscopy to those estimated for the 2 Xpert strategies. Among 139 patients with 142 admissions, median age was 54 years (interquartile range [IQR], 43-60 years); 32 (23%) patients were female, and 42 (30%) were HIV seropositive. Serial sputum smear microscopy and a single concentrated sputum Xpert had identical sensitivity (89%; 95% confidence interval [CI], 52%-100%) and similar specificity (99% [95% CI, 96%-100%] vs 100% [95% CI, 97%-100%]). A single concentrated sputum Xpert could have saved a median of 35 hours (IQR, 24-36 hours) in unnecessary isolation compared with microscopy, and a single unconcentrated sputum Xpert, 45 hours (IQR, 35-46 hours). Replacing serial sputum smear microscopy with a single sputum Xpert could eliminate most unnecessary isolation for inpatients with presumed tuberculosis, greatly benefiting patients and hospitals. © 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.

A SIEPON based transmitter sleep mode energy-efficient mechanism in EPON

NASA Astrophysics Data System (ADS)

Nikoukar, AliAkbar; Hwang, I.-Shyan; Wang, Chien-Jung; Ab-Rahman, Mohammad Syuhaimi; Liem, Andrew Tanny

2015-06-01

The main energy consumption in computer networks is the access networks. The passive optical network (PON) has the least energy consumption among access network technologies. In addition, the time division multiplexing (TDM) Ethernet PON (EPON) is one of the best candidates to improve energy consumption by time utilization. The optical network unit (ONU) can utilize the time and save the energy in the EPON by turning off its transmitter/receiver when there is no upstream/downstream traffic. The ITU-T and IEEE organizations are published standards for energy-saving in the TDM-PON. Although their standards provide the framework to accomplish the energy-saving, the algorithms/criteria to generate events to accommodate various operational policies, time to wake up, parameter values for timers are out of scope of the standards. Many studies have proposed schemes for energy-saving in TDM-PON to achieve maximum energy saving. Even so, these schemes increase the mean packet delay and consequently, reduce the quality of service (QoS). In this paper, first we take a look to the state of the art for PON energy-saving. Additionally, a mechanism based on SIEPON standard in EPON with new components in the ONUs and optical line terminal (OLT) is proposed to save the transmitter energy and guarantee QoS. The proposed mechanism follows the SIEPON standard, considers the QoS first, and then saves the energy as far as possible. The ONU sleep controller unit (OSC) and green dynamic bandwidth allocation (GDBA) are used to calculate the ONU transmitter sleep (Tx) duration and grant the proper time to the ONUs. Simulation results show that the proposed energy-saving mechanism not only promises the QoS performance in terms of mean packet delay, packet loss, throughput, and jitter, but also saves energy in different maximum cycle times.

A versatile program for the calculation of linear accelerator room shielding.

PubMed

Hassan, Zeinab El-Taher; Farag, Nehad M; Elshemey, Wael M

2018-03-22

This work aims at designing a computer program to calculate the necessary amount of shielding for a given or proposed linear accelerator room design in radiotherapy. The program (Shield Calculation in Radiotherapy, SCR) has been developed using Microsoft Visual Basic. It applies the treatment room shielding calculations of NCRP report no. 151 to calculate proper shielding thicknesses for a given linear accelerator treatment room design. The program is composed of six main user-friendly interfaces. The first enables the user to upload their choice of treatment room design and to measure the distances required for shielding calculations. The second interface enables the user to calculate the primary barrier thickness in case of three-dimensional conventional radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT) and total body irradiation (TBI). The third interface calculates the required secondary barrier thickness due to both scattered and leakage radiation. The fourth and fifth interfaces provide a means to calculate the photon dose equivalent for low and high energy radiation, respectively, in door and maze areas. The sixth interface enables the user to calculate the skyshine radiation for photons and neutrons. The SCR program has been successfully validated, precisely reproducing all of the calculated examples presented in NCRP report no. 151 in a simple and fast manner. Moreover, it easily performed the same calculations for a test design that was also calculated manually, and produced the same results. The program includes a new and important feature that is the ability to calculate required treatment room thickness in case of IMRT and TBI. It is characterised by simplicity, precision, data saving, printing and retrieval, in addition to providing a means for uploading and testing any proposed treatment room shielding design. The SCR program provides comprehensive, simple, fast and accurate room shielding calculations in radiotherapy.

Sea Water Air Conditioning (SWAC) at Naval Base Guam: Cost-Benefit Analysis and Acquisition Strategy

DTIC Science & Technology

2015-03-16

significant impact FWS Fish and Wildlife Service GEPA Guam Environmental Protection Agency GPA Guam Power Authority IPT integrated product team...utility energy service contract USACE U.S. Army Corps of Engineers USCG U.S. Coast Guard UXO unexploded ordinance USFWS U.S. Fish and Wildlife ...its bases, such as wind and solar energy. However, ample room remains for new renewable technologies 3 and cost savings at shore installations

Calculation of Level of Comfort of the Micro-Climate in Buildings During the Estimation of the Energy-Saving Measures

NASA Astrophysics Data System (ADS)

Prorokova, M. V.; Bukhmirov, V. V.

2016-02-01

The article describes the method of valuation of comfort of microclimate of residen-tial, public and administrative buildings. The method is based on calculation of the coefficient of thermal comfort of a person in the room. Further amendments are introduced to the asym-metry of the thermal radiation, radiation cooling and air quality. The method serves as the basis for a computer program.

"You Want Your Guests to Be Happy in This Business": Hoteliers' Decisions to Adopt Voluntary Smoke-Free Guest-Room Policies.

PubMed

McDaniel, Patricia A; Malone, Ruth E

2018-01-01

To explore why some hotels have implemented 100% smoke-free policies voluntarily, the perceived consequences of doing so, and media responses. Qualitative study of hotel management and quantitative content analysis of media coverage of smoke-free hotels. Hotels and media based in the United States. Eleven representatives of 5 independent and 4 chain hotels. Other data included 265 news items about smoke-free hotels. We conducted 30-minute semi-structured interviews with hotel representatives and analyzed the data using qualitative content analysis. We also searched 3 online news databases for news items about hotels in our study, and collaboratively coded retrieved items; we analyzed the content and slant of news items. Business considerations, including guest requests, competitor action, and cost savings, were the primary motivations for implementing 100% smoke-free guest-room policies. Health concerns played a minimal role. Hotels received positive feedback from customers and employees. Media coverage was favorable, emphasizing positive aspects of going smoke-free; the overall slant of news items was positive or neutral. However, few hotels marketed the change. Since hotel customers and employees are likely to experience long periods of smoke exposure and smoke-free hotels appear to be so well received, it may be timely to pursue policies making all hotels smoke-free.

Daylight Saving Time Transitions and Road Traffic Accidents

PubMed Central

Lahti, Tuuli; Nysten, Esa; Haukka, Jari; Sulander, Pekka; Partonen, Timo

2010-01-01

Circadian rhythm disruptions may have harmful impacts on health. Circadian rhythm disruptions caused by jet lag compromise the quality and amount of sleep and may lead to a variety of symptoms such as fatigue, headache, and loss of attention and alertness. Even a minor change in time schedule may cause considerable stress for the body. Transitions into and out of daylight saving time alter the social and environmental timing twice a year. According to earlier studies, this change in time-schedule leads to sleep disruption and fragmentation of the circadian rhythm. Since sleep deprivation decreases motivation, attention, and alertness, transitions into and out of daylight saving time may increase the amount of accidents during the following days after the transition. We studied the amount of road traffic accidents one week before and one week after transitions into and out of daylight saving time during years from 1981 to 2006. Our results demonstrated that transitions into and out of daylight saving time did not increase the number of traffic road accidents. PMID:20652036

The Benefits of Streamlined Hip Fracture Management in a Regional Hospital.

PubMed

Mow, T C; Lukeis, Jen; Sutherland, A G

2017-06-01

Hip fracture is an increasingly common injury in the growing elderly population. The morbidity and mortality associated with this injury can be reduced by minimizing delays to surgical treatment. We describe the impact of a regional hospital service redesign project that utilized the principles of smart simplicity, a management strategy that lays emphasis on collaboration to achieve desired goals. Prior to the redesign, patients with hip fractures were taking an average of 72 hours for surgical treatment. A hip fracture working group was created to examine closely the process of hip fracture care, and a single key performance indicator (KPI) of "surgery within 48 hours" was adopted. This allowed identification of processes that could be clarified and streamlined, with the agreement of relevant stakeholders, in the creation of a new hip fracture pathway. In the first 3 months of the pathway's implementation, 16 of 18 patients had surgery within 48 hours of presentation. In a 6-month follow-up audit after 2 years of implementation, 36 of 39 patients were treated within 48 hours. This was significantly different to the time to surgery seen in the 12 months prior to the redesign ( P < .001, Student t test). The mean time to surgery was reduced from 72 hours to 36 hours, a saving in an annual acute bed stay cost of A$152 000. Decreased time to the operating room, the cost savings inherent to this, can be achieved with the introduction of the best standard of care. A redesign that mandates collaboration in achieving a single KPI has allowed a significant culture shift in the treatment of hip fractures in our institution in the months following its institution. Collaborative, multidisciplinary collaboration has facilitated a higher standard of care and demonstrated significant cost benefit.

High-dose inactivated influenza vaccine is associated with cost savings and better outcomes compared to standard-dose inactivated influenza vaccine in Canadian seniors.

PubMed

Becker, Debbie L; Chit, Ayman; DiazGranados, Carlos A; Maschio, Michael; Yau, Eddy; Drummond, Michael

2016-12-01

Seasonal influenza infects approximately 10-20% of Canadians each year, causing an estimated 12,200 hospitalizations and 3,500 deaths annually, mostly occurring in adults ≥65 years old (seniors). A 32,000-participant, randomized controlled clinical trial (FIM12; Clinicaltrials.gov NCT01427309) showed that high-dose inactivated influenza vaccine (IIV-HD) is superior to standard-dose vaccine (SD) in preventing laboratory-confirmed influenza illness in seniors. In this study, we performed a cost-utility analysis (CUA) of IIV-HD versus SD in FIM12 participants from a Canadian perspective. Healthcare resource utilization data collected in FIM12 included: medications, non-routine/urgent care and emergency room visits, and hospitalizations. Unit costs were applied using standard Canadian cost sources to estimate the mean direct medical and societal costs associated with each vaccine (2014 CAD). Clinical illness data from the trial were mapped to quality-of-life data from the literature to estimate differences in effectiveness between vaccines. Time horizon was one influenza season, however, quality-adjusted life-years (QALYs) lost due to death during the study were captured over a lifetime. A probabilistic sensitivity analysis (PSA) was also performed. Average per-participant medical costs were $47 lower and societal costs $60 lower in the IIV-HD arm. Hospitalizations contributed 91% of the total cost and were less frequent in the IIV-HD arm. IIV-HD provided a gain in QALYs and, due to cost savings, dominated SD in the CUA. The PSA indicated that IIV-HD is 89% likely to be cost saving. In Canada, IIV-HD is expected to be a less costly and more effective alternative to SD, driven by a reduction in hospitalizations.

Solar hot water system installed at Quality Inn, Key West, Florida

NASA Astrophysics Data System (ADS)

1980-04-01

The solar energy hot water system installed in the Quality Inn, Key West, Florida, which consists of four buildings is described. Three buildings are low-rise, two-story buildings containing 100 rooms. The fourth is a four-story building with 48 rooms. The solar system was designed to provide approximately 50 percent of the energy required for the domestic hot water system. The solar system consists of approximately 1400 square feet of flat plate collector, two 500 gallon storage tanks, a circulating pump, and a controller. Operation of the system was begun in April 1978, and has continued to date with only three minor interruptions for pump repair. In the first year of operation, it was determined that the use of the solar facility resulted in forty percent fuel savings.

Solar hot water system installed at Quality Inn, Key West, Florida

NASA Technical Reports Server (NTRS)

1980-01-01

The solar energy hot water system installed in the Quality Inn, Key West, Florida, which consists of four buildings is described. Three buildings are low-rise, two-story buildings containing 100 rooms. The fourth is a four-story building with 48 rooms. The solar system was designed to provide approximately 50 percent of the energy required for the domestic hot water system. The solar system consists of approximately 1400 square feet of flat plate collector, two 500 gallon storage tanks, a circulating pump, and a controller. Operation of the system was begun in April 1978, and has continued to date with only three minor interruptions for pump repair. In the first year of operation, it was determined that the use of the solar facility resulted in forty percent fuel savings.

Impact of a University-Based Outpatient Telemedicine Program on Time Savings, Travel Costs, and Environmental Pollutants.

PubMed

Dullet, Navjit W; Geraghty, Estella M; Kaufman, Taylor; Kissee, Jamie L; King, Jesse; Dharmar, Madan; Smith, Anthony C; Marcin, James P

2017-04-01

The objective of this study was to estimate travel-related and environmental savings resulting from the use of telemedicine for outpatient specialty consultations with a university telemedicine program. The study was designed to retrospectively analyze the telemedicine consultation database at the University of California Davis Health System (UCDHS) between July 1996 and December 2013. Travel distances and travel times were calculated between the patient home, the telemedicine clinic, and the UCDHS in-person clinic. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if a visit to the hub site had been necessary. There were 19,246 consultations identified among 11,281 unique patients. Telemedicine visits resulted in a total travel distance savings of 5,345,602 miles, a total travel time savings of 4,708,891 minutes or 8.96 years, and a total direct travel cost savings of $2,882,056. The mean per-consultation round-trip distance savings were 278 miles, average travel time savings were 245 minutes, and average cost savings were $156. Telemedicine consultations resulted in a total emissions savings of 1969 metric tons of CO 2 , 50 metric tons of CO, 3.7 metric tons of NO x , and 5.5 metric tons of volatile organic compounds. This study demonstrates the positive impact of a health system's outpatient telemedicine program on patient travel time, patient travel costs, and environmental pollutants. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A space efficient flexible pivot selection approach to evaluate determinant and inverse of a matrix.

PubMed

Jafree, Hafsa Athar; Imtiaz, Muhammad; Inayatullah, Syed; Khan, Fozia Hanif; Nizami, Tajuddin

2014-01-01

This paper presents new simple approaches for evaluating determinant and inverse of a matrix. The choice of pivot selection has been kept arbitrary thus they reduce the error while solving an ill conditioned system. Computation of determinant of a matrix has been made more efficient by saving unnecessary data storage and also by reducing the order of the matrix at each iteration, while dictionary notation [1] has been incorporated for computing the matrix inverse thereby saving unnecessary calculations. These algorithms are highly class room oriented, easy to use and implemented by students. By taking the advantage of flexibility in pivot selection, one may easily avoid development of the fractions by most. Unlike the matrix inversion method [2] and [3], the presented algorithms obviate the use of permutations and inverse permutations.

Adaptive lighting controllers using smart sensors

NASA Astrophysics Data System (ADS)

Papantoniou, Sotiris; Kolokotsa, Denia; Kalaitzakis, Kostas; Cesarini, Davide Nardi; Cubi, Eduard; Cristalli, Cristina

2016-07-01

The aim of this paper is to present an advanced controller for artificial lights evaluated in several rooms in two European Hospitals located in Chania, Greece and Ancona, Italy. Fuzzy techniques have been used for the architecture of the controller. The energy efficiency of the controllers has been calculated by running the controller coupled with validated models of the RADIANCE back-wards ray tracing software. The input of the controller is the difference between the current illuminance value and the desired one, while the output is the change of the light level that should be applied in the artificial lights. Simulation results indicate significant energy saving potentials. Energy saving potential is calculated from the comparison of the current use of the artificial lights by the users and the proposed one. All simulation work has been conducted using Matlab and RADIANCE environment.

[Evaluation of the influence of humidity and temperature on the drug stability by initial average rate experiment].

PubMed

He, Ning; Sun, Hechun; Dai, Miaomiao

2014-05-01

To evaluate the influence of temperature and humidity on the drug stability by initial average rate experiment, and to obtained the kinetic parameters. The effect of concentration error, drug degradation extent, humidity and temperature numbers, humidity and temperature range, and average humidity and temperature on the accuracy and precision of kinetic parameters in the initial average rate experiment was explored. The stability of vitamin C, as a solid state model, was investigated by an initial average rate experiment. Under the same experimental conditions, the kinetic parameters obtained from this proposed method were comparable to those from classical isothermal experiment at constant humidity. The estimates were more accurate and precise by controlling the extent of drug degradation, changing humidity and temperature range, or by setting the average temperature closer to room temperature. Compared with isothermal experiments at constant humidity, our proposed method saves time, labor, and materials.

Dynamic Nuclear Polarization of 17O: Direct Polarization

PubMed Central

Michaelis, Vladimir K.; Corzilius, Björn; Smith, Albert A.; Griffin, Robert G.

2014-01-01

Dynamic nuclear polarization of 17O was studied using four different polarizing agents – the biradical TOTAPOL, and the monoradicals trityl and SA-BDPA, as well as a mixture of the latter two. Field profiles, DNP mechanisms and enhancements were measured to better understand and optimize directly polarizing this low-gamma quadrupolar nucleus using both mono- and bi-radical polarizing agents. Enhancements were recorded < 88 K and were > 100 using the trityl (OX063) radical and < 10 with the other polarizing agents. The > 10,000 fold savings in acquisition time enabled a series of biologically relevant small molecules to be studied with small sample sizes and the measurement of various quadrupolar parameters. The results are discussed with comparison to room temperature studies and GIPAW quantum chemical calculations. These experimental results illustrate the strength of high field DNP and the importance of radical selection for studying low-gamma nuclei. PMID:24195759

Dynamic nuclear polarization of 17O: direct polarization.

PubMed

Michaelis, Vladimir K; Corzilius, Björn; Smith, Albert A; Griffin, Robert G

2013-12-05

Dynamic nuclear polarization of (17)O was studied using four different polarizing agents: the biradical TOTAPOL and the monoradicals trityl and SA-BDPA, as well as a mixture of the latter two. Field profiles, DNP mechanisms, and enhancements were measured to better understand and optimize directly polarizing this low-gamma quadrupolar nucleus using both mono- and biradical polarizing agents. Enhancements were recorded at <88 K and were >100 using the trityl (OX063) radical and <10 with the other polarizing agents. The >10,000-fold savings in acquisition time enabled a series of biologically relevant small molecules to be studied with small sample sizes and the measurement of various quadrupolar parameters. The results are discussed with comparison to room temperature studies and GIPAW quantum chemical calculations. These experimental results illustrate the strength of high field DNP and the importance of radical selection for studying low-gamma nuclei.

Sea Water Air Conditioning (SWAC) at Naval Base Guam: Cost-Beneit Analysis and Acquisition Strategy

DTIC Science & Technology

2014-12-01

Fish and Wildlife Service GEPA Guam Environmental Protection Agency GPA Guam Power Authority IPT integrated product team MILCON military...energy service contract USACE U.S. Army Corps of Engineers USCG U.S. Coast Guard UXO unexploded ordinance USFWS U.S. Fish and Wildlife Service WOD13...options for its bases, such as wind and solar energy. However, ample room remains for new renewable technologies 3 and cost savings at shore

Environmental impacts of divorce.

PubMed

Yu, Eunice; Liu, Jianguo

2007-12-18

Divorce is increasingly common around the world. Its causes, dynamics, and socioeconomic impacts have been widely studied, but little research has addressed its environmental impacts. We found that average household size (number of people in a household) in divorced households (households with divorced heads) was 27-41% smaller than married households (households with married heads) in 12 countries across the world around the year 2000 (between 1998 and 2002). If divorced households had combined to have the same average household size as married households, there could have been 7.4 million fewer households in these countries. Meanwhile, the number of rooms per person in divorced households was 33-95% greater than in married households. In the United States (U.S.) in 2005, divorced households spent 46% and 56% more on electricity and water per person than married households. Divorced households in the U.S. could have saved more than 38 million rooms, 73 billion kilowatt-hours of electricity, and 627 billion gallons of water in 2005 alone if their resource-use efficiency had been comparable to married households. Furthermore, U.S. households that experienced divorce used 42-61% more resources per person than before their dissolution. Remarriage of divorced household heads increased household size and reduced resource use to levels similar to those of married households. The results suggest that mitigating the impacts of resource-inefficient lifestyles such as divorce helps to achieve global environmental sustainability and saves money for households.

Fatal alcohol-related traffic crashes increase subsequent to changes to and from daylight savings time.

PubMed

Hicks, G J; Davis, J W; Hicks, R A

1998-06-01

On the hypothesis that sleepiness and alcohol interact to increase the risk of alcohol-related traffic fatalities, the percentages of alcohol-related fatal traffic crashes were assessed for the entire state of New Mexico for the years 1989-1992, for each of the seven days that preceded the changes to and from Daylight Savings Time and for each of the 14 days which followed the changes to and from Daylight Savings Time. Consistent with our hypothesis the percentage of alcohol-related fatal crashes increased significantly during the first seven days after these changes in Daylight Savings Time.

Daylight saving time transitions and hospital treatments due to accidents or manic episodes

PubMed Central

Lahti, Tuuli A; Haukka, Jari; Lönnqvist, Jouko; Partonen, Timo

2008-01-01

Background Daylight saving time affects millions of people annually but its impacts are still widely unknown. Sleep deprivation and the change of circadian rhythm can trigger mental illness and cause higher accident rates. Transitions into and out of daylight saving time changes the circadian rhythm and may cause sleep deprivation. Thus it seems plausible that the prevalence of accidents and/or manic episodes may be higher after transition into and out of daylight saving time. The aim of this study was to explore the effects of transitions into and out of daylight saving time on the incidence of accidents and manic episodes in the Finnish population during the years of 1987 to 2003. Methods The nationwide data were derived from the Finnish Hospital Discharge Register. From the register we obtained the information about the hospital-treated accidents and manic episodes during two weeks before and two weeks after the transitions in 1987–2003. Results The results were negative, as the transitions into or out of daylight saving time had no significant effect on the incidence of accidents or manic episodes. Conclusion One-hour transitions do not increase the incidence of manic episodes or accidents which require hospital treatment. PMID:18302734

The long term financial impacts of CVD: living standards in retirement.

PubMed

Schofield, Deborah; Kelly, Simon; Shrestha, Rupendra; Passey, Megan; Callander, Emily; Percival, Richard

2012-03-22

Cardiovascular disease (CVD) has significant economic costs, however these are generally estimated for the present-time and little consideration is given to the long term economic consequences. This study estimates the value of savings those who retire early due to CVD will have accumulated by the time they reach the traditional retirement age of 65 years, and how much lower the value of these savings are compared to those who remained healthy and in the workforce. Using Health&WealthMOD - a microsimulation model of Australians aged 45 to 64 years, regression models were used to analyse the differences between the projected savings and the retirement incomes of people by the time they reach age 65 for those currently working with no chronic condition, and people not in the labour force due to CVD. Over 99% of individuals who are employed full-time will have accumulated some savings at age 65; whereas only 77% of those who are out of the labour force due to CVD will have done so. Those who retire early due to CVD will have a median value of total savings by the time they are 65 of $1833. This is far lower than the expected median value of savings for those who remained in the labour force full-time, who will have $281841 of savings. Not only will early retirement due to cardiovascular disease limit the immediate income and wealth available to individuals, but also reduce their long term financial capacity by reducing their savings. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

[Saving motives in young, middle-aged, and older adults. Preliminary results of a new inventory for exploring lifespan saving motives].

PubMed

Rager, B; Lang, F R; Wagner, G G

2012-12-01

There is some research on personal reasons for saving money in the economic sciences. However, not much is known about the age differences of saving motives. In this vein, the future time perspective (FTP) is known to play a critical role for motivation across the life span. In this study, we introduce a new Saving Motive Inventory (SMI), which also covers saving goals after retirement. Furthermore, it is argued that additional saving motives that are not based on economic models of life-cycle saving also exist. In accordance with the socio-emotional selectivity theory, we explored age differences in an online survey with 496 participants from young (19-44 years), middle-aged (45-64 years), and older (65-86 years) adulthood, who completed a questionnaire on saving motives, personality, and future-related thinking (e.g., Future Time Perspective Scale, Life Orientation Test). Results of the explorative Factor Analysis (EFA) are consistent with the theoretical expectations. The factors are generativity, educational investment, consumption, indifference, and provision for death and dying. Together these five factors account for 67% of the variance. In general, the inventory is reliable and valid with respect to the expected internal and external criteria. It contributes to better understanding of saving motives over the lifespan, especially with respect to effects of the future time perspective.

Time Management in the Operating Room: An Analysis of the Dedicated Minimally Invasive Surgery Suite

PubMed Central

Hsiao, Kenneth C.; Machaidze, Zurab

2004-01-01

Background: Dedicated minimally invasive surgery suites are available that contain specialized equipment to facilitate endoscopic surgery. Laparoscopy performed in a general operating room is hampered by the multitude of additional equipment that must be transported into the room. The objective of this study was to compare the preparation times between procedures performed in traditional operating rooms versus dedicated minimally invasive surgery suites to see whether operating room efficiency is improved in the specialized room. Methods: The records of 50 patients who underwent laparoscopic procedures between September 2000 and April 2002 were retrospectively reviewed. Twenty-three patients underwent surgery in a general operating room and 18 patients in an minimally invasive surgery suite. Nine patients were excluded because of cystoscopic procedures undergone prior to laparoscopy. Various time points were recorded from which various time intervals were derived, such as preanesthesia time, anesthesia induction time, and total preparation time. A 2-tailed, unpaired Student t test was used for statistical analysis. Results: The mean preanesthesia time was significantly faster in the minimally invasive surgery suite (12.2 minutes) compared with that in the traditional operating room (17.8 minutes) (P=0.013). Mean anesthesia induction time in the minimally invasive surgery suite (47.5 minutes) was similar to time in the traditional operating room (45.7 minutes) (P=0.734). The average total preparation time for the minimally invasive surgery suite (59.6 minutes) was not significantly faster than that in the general operating room (63.5 minutes) (P=0.481). Conclusion: The amount of time that elapses between the patient entering the room and anesthesia induction is statically shorter in a dedicated minimally invasive surgery suite. Laparoscopic surgery is performed more efficiently in a dedicated minimally invasive surgery suite versus a traditional operating room. PMID:15554269

The effectiveness of the 55 MPH national maximum speed limit as a life saving benefit

DOT National Transportation Integrated Search

1980-10-01

The report contains an analysis of the life saving benefits resulting from the 55 mph NMSL from 1974-1979. Monthly fatality data from 1970-1979 was used in a time series model to arrive at the estimated safety benefits (lives saved). The time series ...

An energy saving mechanism of EPON networks for real time video transmission

NASA Astrophysics Data System (ADS)

Liu, Chien-Ping; Wu, Ho-Ting; Chiang, Yun-Ting; Chien, Shieh-Chieh; Ke, Kai-Wei

2015-07-01

Modern access networks are constructed widely by passive optical networks (PONs) to meet the growing bandwidth demand. However, higher bandwidth means more energy consumption. To save energy, a few research works propose the dual-mode energy saving mechanism that allows the ONU to operate between active and sleep modes periodically. However, such dual-mode energy saving design may induce unnecessary power consumption or packet delay increase in the case where only downstream data exist for most of the time. In this paper, we propose a new tri-mode energy saving scheme for Ethernet PON (EPON). The new tri-mode energy saving design, combining the dual-mode saving mechanism with the doze mode, allows the ONU to switch among these three modes alternatively. In the doze mode, the ONU may receive downstream data while keeping its transmitter close. Such scenario is often observed for real time video downstream transmission. Furthermore, the low packet delay of high priority upstream data can be attained through the use of early wake-up mechanism employed in both energy saving modes. The energy saving and system efficiency can thus be achieved jointly while maintaining the differentiated QoS for data with various priorities. Performance results via simulation have demonstrated the effectiveness of such mechanism.

Reducing Operating Room Costs Through Real-Time Cost Information Feedback: A Pilot Study.

PubMed

Tabib, Christian H; Bahler, Clinton D; Hardacker, Thomas J; Ball, Kevin M; Sundaram, Chandru P

2015-08-01

To create a protocol for providing real-time operating room (OR) cost feedback to surgeons. We hypothesize that this protocol will reduce costs in a responsible way without sacrificing quality of care. All OR costs were obtained and recorded for robot-assisted partial nephrectomy and laparoscopic donor nephrectomy. Before the beginning of this project, costs pertaining to the 20 most recent cases were analyzed. Items were identified from previous cases as modifiable for replacement or omission. Timely feedback of total OR costs and cost of each item used was provided to the surgeon after each case, and costs were analyzed. A cost analysis of the robot-assisted partial nephrectomy before the washout period indicates expenditures of $5243.04 per case. Ten recommended modifiable items were found to have an average per case cost of $1229.33 representing 23.4% of the total cost. A postwashout period cost analysis found the total OR cost decreased by $899.67 (17.2%) because of changes directly related to the modifiable items. Therefore, 73.2% of the possible identified savings was realized. The same stepwise approach was applied to laparoscopic donor nephrectomies. The average total cost per case before the washout period was $3530.05 with $457.54 attributed to modifiable items. After the washout period, modifiable items costs were reduced by $289.73 (8.0%). No complications occurred in the donor nephrectomy cases while one postoperative complication occurred in the partial nephrectomy group. Providing surgeons with feedback related to OR costs may lead to a change in surgeon behavior and decreased overall costs. Further studies are needed to show equivalence in patient outcomes.

Reinforcement Learning and Savings Behavior.

PubMed

Choi, James J; Laibson, David; Madrian, Brigitte C; Metrick, Andrew

2009-12-01

We show that individual investors over-extrapolate from their personal experience when making savings decisions. Investors who experience particularly rewarding outcomes from saving in their 401(k)-a high average and/or low variance return-increase their 401(k) savings rate more than investors who have less rewarding experiences with saving. This finding is not driven by aggregate time-series shocks, income effects, rational learning about investing skill, investor fixed effects, or time-varying investor-level heterogeneity that is correlated with portfolio allocations to stock, bond, and cash asset classes. We discuss implications for the equity premium puzzle and interventions aimed at improving household financial outcomes.

A Business Case for Nuclear Plant Control Room Modernization

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

Thomas, Ken; Lawrie, Sean; Niedermuller, Josef M.

This paper presents a generic business case for implementation of technology that supports Control Room Modernization (CRM). The analysis presented in two forms; 1) a standalone technology upgrade, and 2) a technology upgrade that is built upon and incremental to a prior business case created for Mobile Work Packages (MWP). The business case contends that advanced communication and networking and analytical technologies will allow NPP to conduct control room operations with improved focus by reducing human factors and redundant manpower, and therefore operate with fewer errors. While some labor savings can be harvested in terms of overtime, the majority ofmore » savings are demonstrated as reduced time to take the plant off line and bring back on line in support of outages. The benefits are quantified to a rough order of magnitude that provides directional guidance to NPPs that are interested in developing a similar business case. This business case focuses on modernization of the operator control room and does not consider a complete overhaul and modernization of a plants instrument and control systems. While operators may be considering such an investment at their plants, the sizable capital investment required is not likely supported by a cost/benefit analysis alone. More likely, it is driven by obsolescence and reliability issues, and requires consideration of mechanical condition of plant systems, capital depreciation, financing, relicensing and overall viability of the plant asset over a 20-year horizon in a competitive market. Prior studies [REF] have indicated that such a modernization of plant I&C systems, alone or as part of a larger modernization effort, can yield very significant reductions in O&M costs. However, the depth of research and analysis required to develop a meaningful business case for a plant modernization effort is well beyond the scope of this study. While CRM as considered in this study can be easily integrated as part of grander plant modernization effort, it can also be considered as a stand-alone project, implemented as a supervisorial layer over and above existing systems. CRM is enabled by a suite of technologies, which are described in further detail in the body of this report. They include: • Modernized control room with interactive displays • High-bandwidth wireless networks • Mobile devices • Component identification technology • Mobile wireless video cameras • Smart or task based operator displays • Computer-Based Procedures (CBP)/Automated Mobile Work Packages (MWP) • Intelligent plant configuration • Advanced data analytics An analysis was conducted to determine how these technologies might impact outage operations at an NPP. The analysis concluded that outage management capabilities would be improved with application of these technologies, and result in annual benefits for the plant. These improved capabilities were identified and described in further detail in this report. • Reduction in need redundant manpower (verification, etc) • Improved critical path shutdown and restart duration during outages • Reduction in human factors and errors • Remote watches • Paperless outage coordination • Bulk work optimization« less

Energy Savings Lifetimes and Persistence

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

Hoffman, Ian M.; Schiller, Steven R.; Todd, Annika

2016-02-01

This technical brief explains the concepts of energy savings lifetimes and savings persistence and discusses how program administrators use these factors to calculate savings for efficiency measures, programs and portfolios. Savings lifetime is the length of time that one or more energy efficiency measures or activities save energy, and savings persistence is the change in savings throughout the functional life of a given efficiency measure or activity. Savings lifetimes are essential for assessing the lifecycle benefits and cost effectiveness of efficiency activities and for forecasting loads in resource planning. The brief also provides estimates of savings lifetimes derived from amore » national collection of costs and savings for electric efficiency programs and portfolios.« less

Utilizing Diffusion Theory to predict carbon dioxide concentration in an indoor environment

NASA Astrophysics Data System (ADS)

Kramer, Andrew R.

This research details a new method of relating sources of carbon dioxide to carbon dioxide concentration in a room operating in a reduced ventilation mode by utilizing Diffusion Theory. The theoretical basis of this research involved solving Fick's Second Law of Diffusion in spherical coordinates for a source of carbon dioxide flowing at a constant rate and located in the center of an impermeable spherical boundary. The solution was developed using a Laplace Transformation. A spherical diffusion test chamber was constructed and used to validate and benchmark the developed theory. The method was benchmarked by using Dispersion Coefficients for large carbon dioxide flow rates due to diffusion induced convection. The theoretical model was adapted to model a room operating with restricted ventilation in the presence of a known, constant source of carbon dioxide. The room was modeled as a sphere of volume equal to the room and utilized a Dispersion Coefficient that is consistent with published values. The developed Diffusion Model successfully predicted the spatial concentration of carbon dioxide in a room operating in a reduced ventilation mode in the presence of a source of carbon dioxide. The flow rates of carbon dioxide that were used in the room are comparable to the average flow rate of carbon dioxide from a person during quiet breathing, also known as the Tidal Breathing. This indicates the Diffusion Model developed from this research has the potential to correlate carbon dioxide concentration with static occupancy levels which can lead to energy savings through a reduction in air exchange rates when low occupancy is detected.

Comparing the Medicaid Retrospective Drug Utilization Review Program Cost-Savings Methods Used by State Agencies

PubMed Central

Prada, Sergio I.

2017-01-01

Background The Medicaid Drug Utilization Review (DUR) program is a 2-phase process conducted by Medicaid state agencies. The first phase is a prospective DUR and involves electronically monitoring prescription drug claims to identify prescription-related problems, such as therapeutic duplication, contraindications, incorrect dosage, or duration of treatment. The second phase is a retrospective DUR and involves ongoing and periodic examinations of claims data to identify patterns of fraud, abuse, underutilization, drug–drug interaction, or medically unnecessary care, implementing corrective actions when needed. The Centers for Medicare & Medicaid Services requires each state to measure prescription drug cost-savings generated from its DUR programs on an annual basis, but it provides no guidance or unified methodology for doing so. Objectives To describe and synthesize the methodologies used by states to measure cost-savings using their Medicaid retrospective DUR program in federal fiscal years 2014 and 2015. Method For each state, the cost-savings methodologies included in the Medicaid DUR 2014 and 2015 reports were downloaded from Medicaid's website. The reports were then reviewed and synthesized. Methods described by the states were classified according to research designs often described in evaluation textbooks. Discussion In 2014, the most often used prescription drugs cost-savings estimation methodology for the Medicaid retrospective DUR program was a simple pre-post intervention method, without a comparison group (ie, 12 states). In 2015, the most common methodology used was a pre-post intervention method, with a comparison group (ie, 14 states). Comparisons of savings attributed to the program among states are still unreliable, because of a lack of a common methodology available for measuring cost-savings. Conclusion There is great variation among states in the methods used to measure prescription drug utilization cost-savings. This analysis suggests that there is still room for improvement in terms of methodology transparency, which is important, because lack of transparency hinders states from learning from each other. Ultimately, the federal government needs to evaluate and improve its DUR program. PMID:29403573

Advanced visualization platform for surgical operating room coordination: distributed video board system.

PubMed

Hu, Peter F; Xiao, Yan; Ho, Danny; Mackenzie, Colin F; Hu, Hao; Voigt, Roger; Martz, Douglas

2006-06-01

One of the major challenges for day-of-surgery operating room coordination is accurate and timely situation awareness. Distributed and secure real-time status information is key to addressing these challenges. This article reports on the design and implementation of a passive status monitoring system in a 19-room surgical suite of a major academic medical center. Key design requirements considered included integrated real-time operating room status display, access control, security, and network impact. The system used live operating room video images and patient vital signs obtained through monitors to automatically update events and operating room status. Images were presented on a "need-to-know" basis, and access was controlled by identification badge authorization. The system delivered reliable real-time operating room images and status with acceptable network impact. Operating room status was visualized at 4 separate locations and was used continuously by clinicians and operating room service providers to coordinate operating room activities.

31 CFR 315.10 - Limitations.

Code of Federal Regulations, 2013 CFR

2013-07-01

... each series of bonds and savings notes for each specific year, which has varied from time to time, can..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING U.S. SAVINGS BONDS, SERIES A, B, C.... Specific limitations have been placed on the amounts of bonds of each series and savings notes that might...

31 CFR 315.10 - Limitations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... each series of bonds and savings notes for each specific year, which has varied from time to time, can..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING U.S. SAVINGS BONDS, SERIES A, B, C.... Specific limitations have been placed on the amounts of bonds of each series and savings notes that might...

31 CFR 315.10 - Limitations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... each series of bonds and savings notes for each specific year, which has varied from time to time, can..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING U.S. SAVINGS BONDS, SERIES A, B, C.... Specific limitations have been placed on the amounts of bonds of each series and savings notes that might...

31 CFR 315.10 - Limitations.

Code of Federal Regulations, 2012 CFR

2012-07-01

... each series of bonds and savings notes for each specific year, which has varied from time to time, can..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING U.S. SAVINGS BONDS, SERIES A, B, C.... Specific limitations have been placed on the amounts of bonds of each series and savings notes that might...

Next Generation Luminaire (NGL) Downlight Demonstration Project, Hilton Columbus Downtown

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

Davis, R. G.; Perrin, T. E.

2014-09-30

At the Hilton Columbus Downtown hotel in Ohio, DOE's Better Buildings Alliance conducted a demonstration of Next Generation Luminaires-winning downlights installed in all guest rooms and suites prior to the hotel's 2012 opening. After a post-occupancy assessment, the LED downlights not only provided the aesthetic appearance and dimming functionality desired, but also provided 50% energy savings relative to a comparable CFL downlight and enabled the lighting power to be more than 20% below that allowed by code.

Saving a Drug Poisoning Victim: A Kinetics Simulation

NASA Astrophysics Data System (ADS)

Selco, Jodye I.; Beery, Janet

2002-05-01

In this project, students, posing as hospital emergency room physicians, must save the life of a child who has accidentally overdosed on the asthma medication, theophylline. The progress of the drug through the child's body can be modeled as a chemical kinetics problem involving first-order consecutive reactions. Students begin by setting up a system of linear first-order differential equations describing the medication's absorption into and elimination from the child's bloodstream using half-lives obtained from the Physician's Desk Reference. By using a computer to solve the differential equations numerically, students discover that the child will almost certainly die if they, as physicians, do not intervene. The students then determine by how much they need to increase the drug's elimination rate in order to save the child. This dictates the appropriate medical action. Students discover that they need to use the more drastic treatment of extracorporeal filtering of the blood through charcoal, rather than simply administering oral doses of charcoal. We've found that this project appeals to a broad range of students; many students are interested in careers in the health professions and all are intrigued by the child's grave situation.

Analysis of wallboard containing a phase change material

NASA Astrophysics Data System (ADS)

Tomlinson, J. J.; Heberle, D. P.

Phase change materials (PCMs) used on the interior of buildings hold the promise for improved thermal performance by reducing the energy requirements for space conditioning and by improving thermal comfort by reducing temperature swings inside the building. Efforts are underway to develop a gypsum wallboard containing a hydrocarbon PCM. With a phase change temperature in the room temperature range, the PCM wallboard adds substantially to the thermal mass of the building while serving the same architectural function as conventional wallboard. To determine the thermal and economic performance of this PCM wallboard, the Transient Systems Simulation Program (TRNSYS) was modified to accommodate walls that are covered with PCM plasterboard, and to apportion the direct beam solar radiation to interior surfaces of a building. The modified code was used to simulate the performance of conventional and direct-gain passive solar residential-sized buildings with and without PCM wallboard. Space heating energy savings were determined as a function of PCM wallboard characteristics. Thermal comfort improvements in buildings containing the PCM were qualified in terms of energy savings. The report concludes with a present worth economic analysis of these energy savings and arrives at system costs and economic payback based on current costs of PCMs under study for the wallboard application.

31 CFR 321.27 - Supplements, amendments, or revisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... FINANCIAL INSTITUTIONS OF UNITED STATES SAVINGS BONDS AND UNITED STATES SAVINGS NOTES (FREEDOM SHARES... any time or from time to time, revise, supplement, amend or withdraw, in whole or in part, the...

Tonsillectomy in children and in adults: changes in practice following the opening of a day-surgery unit with dedicated operating room.

PubMed

Bartier, S; Gharzouli, I; Kiblut, N; Bendimered, H; Cloutier, L; Salvan, D

2018-05-30

To study the impact of the opening of a day-surgery unit on the practice of tonsillectomy in adults and children in the light of the experience of our department, and to compare complications between day-surgery and conventional admission. A retrospective review was conducted of all tonsillectomies performed since the opening of a dedicated day-surgery room, using the ENT and emergency department data-bases. Between October 2013 and December 2014, 179 tonsillectomies were performed (51 in adults, 128 in children), including 108 day-surgeries. Between 2012 and 2014, the number of tonsillectomies increased by 12.7%, with an 18.27% increase in children and stable adult rate. Within 1 year, day-surgery became predominant for children (73.19%) and equaled conventional admission for adults (47.22%). For almost all patients without same-day discharge, the reasons were organizational or due to malorientation (comorbidity, or unsuitable home environment). Day-case tonsillectomy in children showed a 30-day complications rate comparable to those reported in the literature (8.3% postoperative hemorrhage), with a higher rate in adults (35.3%). Onset of complications was at a mean 6 days in adults and 9 days in children; only 2 patients developed complications between 6 and 24hours postoperatively. The present study showed that opening a day-surgery unit led to changes in practice, with most tonsillectomies now performed on an outpatient basis, without increased complications, and notably immediate complications. Outpatient tonsillectomy thus seems to be a solution of choice compared to conventional admission, in terms of cost saving and of patient comfort, without sacrificing safety. The dedicated operating room facilitates scheduling and thereby increasing turnover by reducing wait time. Copyright © 2018. Published by Elsevier Masson SAS.

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.

Improving the economic and humanistic outcomes for diabetic patients: making a case for employer-sponsored medication therapy management

PubMed Central

Pinto, Sharrel L; Kumar, Jinender; Partha, Gautam; Bechtol, Robert A

2013-01-01

Background The purpose of this study was to determine the cost savings of a pharmacist-led, employer-sponsored medication therapy management (MTM) program for diabetic patients and to assess for any changes in patient satisfaction and self-reported medication adherence for enrollees. Methods Participants in this study were enrollees of an employer-sponsored MTM program. They were included if their primary medical insurance and prescription coverage was from the City of Toledo, they had a diagnosis of type 2 diabetes, and whether or not they had been on medication or had been given a new prescription for diabetes treatment. The data were analyzed on a prospective, pre-post longitudinal basis, and tracked for one year following enrollment. Outcomes included economic costs, patient satisfaction, and self-reported patient adherence. Descriptive statistics were used to characterize the population, calculate the number of visits, and determine the mean costs for each visit. Friedman’s test was used to determine changes in outcomes due to the nonparametric nature of the data. Results The mean number of visits to a physician’s office decreased from 10.22 to 7.07. The mean cost of these visits for patients increased from $47.70 to $66.41, but use of the emergency room and inpatient visits decreased by at least 50%. Employer spending on emergency room visits decreased by $24,214.17 and inpatient visit costs decreased by $166,610.84. Office visit spending increased by $11,776.41. A total cost savings of $179,047.80 was realized by the employer at the end of the program. Significant improvements in patient satisfaction and adherence were observed. Conclusion Pharmacist interventions provided through the employer-sponsored MTM program led to substantial cost savings to the employer with improved patient satisfaction and adherence on the part of employees at the conclusion of the program. PMID:23610526

Reinforcement Learning and Savings Behavior*

PubMed Central

Choi, James J.; Laibson, David; Madrian, Brigitte C.; Metrick, Andrew

2009-01-01

We show that individual investors over-extrapolate from their personal experience when making savings decisions. Investors who experience particularly rewarding outcomes from saving in their 401(k)—a high average and/or low variance return—increase their 401(k) savings rate more than investors who have less rewarding experiences with saving. This finding is not driven by aggregate time-series shocks, income effects, rational learning about investing skill, investor fixed effects, or time-varying investor-level heterogeneity that is correlated with portfolio allocations to stock, bond, and cash asset classes. We discuss implications for the equity premium puzzle and interventions aimed at improving household financial outcomes. PMID:20352013

Saving in cycles: how to get people to save more money.

PubMed

Tam, Leona; Dholakia, Utpal

2014-02-01

Low personal savings rates are an important social issue in the United States. We propose and test one particular method to get people to save more money that is based on the cyclical time orientation. In contrast to conventional, popular methods that encourage individuals to ignore past mistakes, focus on the future, and set goals to save money, our proposed method frames the savings task in cyclical terms, emphasizing the present. Across the studies, individuals who used our proposed cyclical savings method, compared with individuals who used a linear savings method, provided an average of 74% higher savings estimates and saved an average of 78% more money. We also found that the cyclical savings method was more efficacious because it increased implementation planning and lowered future optimism regarding saving money.

Sci-Thur PM – Brachytherapy 04: Commissioning and Implementation of a Cobalt-60 High Dose Rate Brachytherapy Source

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

Dysart, Jonathan

An Eckert & Ziegler Bebig Co0.A86 cobalt 60 high dose rate (HDR) brachytherapy source was commissioned for clinical use. Long-lived Co-60 HDR sources offer potential logistical and economic advantages over Ir-192 sources, and should be considered for low to medium workload brachytherapy departments where modest increases in treatment times are not a factor. In optimized plans, the Co-60 source provides a similar dose distribution to Ir-192 despite the difference in radiation energy. By switching to Co-60, source exchange frequency can be reduced by a factor of 20, resulting in overall financial savings of more than 50% compared to Ir-192 sources.more » In addition, a reduction in Physicist QA workload of roughly 200 hours over the 5 year life of the Co-60 source is also expected. These benefits should be considered against the modest increases in average treatment time compared to those of Ir-192 sources, as well as the centre-specific needs for operating room shielding modification.« less

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

PubMed

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

2011-02-01

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

31 CFR 351.6 - When may I redeem my Series EE savings bond?

Code of Federal Regulations, 2012 CFR

2012-07-01

... before January 1, 2003. You may redeem your Series EE savings bond at any time beginning six months after... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false When may I redeem my Series EE savings... SAVINGS BONDS, SERIES EE Maturities, Redemption Values, and Investment Yields of Series EE Savings Bonds...

31 CFR 351.6 - When may I redeem my Series EE savings bond?

Code of Federal Regulations, 2013 CFR

2013-07-01

... before January 1, 2003. You may redeem your Series EE savings bond at any time beginning six months after... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false When may I redeem my Series EE savings... SAVINGS BONDS, SERIES EE Maturities, Redemption Values, and Investment Yields of Series EE Savings Bonds...

31 CFR 351.6 - When may I redeem my Series EE savings bond?

Code of Federal Regulations, 2011 CFR

2011-07-01

... before January 1, 2003. You may redeem your Series EE savings bond at any time beginning six months after... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false When may I redeem my Series EE savings... SAVINGS BONDS, SERIES EE Maturities, Redemption Values, and Investment Yields of Series EE Savings Bonds...

[Telemetric monitoring reduces visits to the emergency room and cost of care in patients with chronic heart failure].

PubMed

Pérez-Rodríguez, Gilberto; Brito-Zurita, Olga Rosa; Sistos-Navarro, Enrique; Benítez-Aréchiga, Zaria Margarita; Sarmiento-Salazar, Gloria Leticia; Vargas-Lizárraga, José Feliciano

2015-01-01

Tele-cardiology is the use of information technologies that help prolong survival, improve quality of life and reduce costs in health care. Heart failure is a chronic disease that leads to high care costs. To determine the effectiveness of telemetric monitoring for controlling clinical variables, reduced emergency room visits, and cost of care in a group of patients with heart failure compared to traditional medical consultation. A randomized, controlled and open clinical trial was conducted on 40 patients with Heart failure in a tertiary care centre in north-western Mexico. The patients were divided randomly into 2 groups of 20 patients each (telemetric monitoring, traditional medical consultation). In each participant was evaluated for: blood pressure, heart rate and body weight. The telemetric monitoring group was monitored remotely and traditional medical consultation group came to the hospital on scheduled dates. All patients could come to the emergency room if necessary. The telemetric monitoring group decreased their weight and improved control of the disease (P=.01). Systolic blood pressure and cost of care decreased (51%) significantly compared traditional medical consultation group (P>.05). Admission to the emergency room was avoided in 100% of patients in the telemetric monitoring group. In patients with heart failure, the telemetric monitoring was effective in reducing emergency room visits and saved significant resources in care during follow-up. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Trial of real-time locating and messaging system with Bluetooth low energy.

PubMed

Arisaka, Naoya; Mamorita, Noritaka; Isonaka, Risa; Kawakami, Tadashi; Takeuchi, Akihiro

2016-09-14

Hospital real-time location systems (RTLS) are increasing efficiency and reducing operational costs, but room access tags are necessary. We developed three iPhone 5 applications for an RTLS and communications using Bluetooth low energy (BLE). The applications were: Peripheral device tags, Central beacons, and a Monitor. A Peripheral communicated with a Central using BLE. The Central communicated with a Monitor using sockets on TCP/IP (Transmission Control Protocol/Internet Protocol) via a WLAN (wireless local area network). To determine a BLE threshold level for the received signal strength indicator (RSSI), relationships between signal strength and distance were measured in our laboratory and on the terrace. The BLE RSSI threshold was set at -70 dB, about 10 m. While an individual with a Peripheral moved around in a concrete building, the Peripheral was captured in a few 10-sec units at about 10 m from a Central. The Central and Monitor showed and saved the approach events, location, and Peripheral's nickname sequentially in real time. Remote Centrals also interactively communicate with Peripherals by intermediating through Monitors that found the nickname in the event database. Trial applications using BLE on iPhones worked well for patient tracking, and messaging in indoor environments.

VA Telemedicine: An Analysis of Cost and Time Savings.

PubMed

Russo, Jack E; McCool, Ryan R; Davies, Louise

2016-03-01

The Veterans Affairs (VA) healthcare system provides beneficiary travel reimbursement ("travel pay") to qualifying patients for traveling to appointments. Travel pay is a large expense for the VA and hence the U.S. Government, projected to cost nearly $1 billion in 2015. Telemedicine in the VA system has the potential to save money by reducing patient travel and thus the amount of travel pay disbursed. In this study, we quantify this savings and also report trends in VA telemedicine volumes over time. All telemedicine visits based at the VA Hospital in White River Junction, VT between 2005 and 2013 were reviewed (5,695 visits). Travel distance and time saved as a result of telemedicine were calculated. Clinical volume in the mental health department, which has had the longest participation in telemedicine, was analyzed. Telemedicine resulted in an average travel savings of 145 miles and 142 min per visit. This led to an average travel payment savings of $18,555 per year. Telemedicine volume grew significantly over the study period such that by the final year the travel pay savings had increased to $63,804, or about 3.5% of the total travel pay disbursement for that year. The number of mental health telemedicine visits rose over the study period but remained small relative to the number of face-to-face visits. A higher proportion of telemedicine visits involved new patients. Telemedicine at the VA saves travel distance and time, although the reduction in travel payments remains modest at current telemedicine volumes.

Hospital factors impact variation in emergency department length of stay more than physician factors.

PubMed

Krall, Scott P; Cornelius, Angela P; Addison, J Bruce

2014-03-01

To analyze the correlation between the many different emergency department (ED) treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the "door to room" interval in an ED (interval determined by ED bed availability). Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval. We collected daily interval averages from the ED information system, Meditech©. Patient flow metrics were collected on a 24-hour basis. We analyzed the relationship between the time intervals that make up an ED visit and the "arrival to room" interval using simple correlation (Pearson Correlation coefficients). Summary statistics of industry standard metrics were also done by dividing the intervals into 2 groups, based on the average ED length of stay (LOS) from the National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary. Simple correlation analysis showed that the doctor-to-discharge time interval had no correlation to the interval of "door to room (waiting room time)", correlation coefficient (CC) (CC=0.000, p=0.96). "Room to doctor" had a low correlation to "door to room" CC=0.143, while "decision to admitted patients departing the ED time" had a moderate correlation of 0.29 (p <0.001). "New arrivals" (daily patient census) had a strong correlation to longer "door to room" times, 0.657, p<0.001. The "door to discharge" times had a very strong correlation CC=0.804 (p<0.001), to the extended "door to room" time. Physician-dependent intervals had minimal correlation to the variation in arrival to room time. The "door to room" interval was a significant component to the variation in "door to discharge" i.e. LOS. The hospital-influenced "admit decision to hospital bed" i.e. hospital inpatient capacity, interval had a correlation to delayed "door to room" time. The other major factor affecting department bed availability was the "total patients per day." The correlation to the increasing "door to room" time also reflects the effect of availability of ED resources (beds) on the patient evaluation time. The time that it took for a patient to receive a room appeared more dependent on the system resources, for example, beds in the ED, as well as in the hospital, than on the physician.

Short-term versus long-term rainfall time series in the assessment of potable water savings by using rainwater in houses.

PubMed

Ghisi, Enedir; Cardoso, Karla Albino; Rupp, Ricardo Forgiarini

2012-06-15

The main objective of this article is to assess the possibility of using short-term instead of long-term rainfall time series to evaluate the potential for potable water savings by using rainwater in houses. The analysis was performed considering rainfall data from 1960 to 1995 for the city of Santa Bárbara do Oeste, located in the state of São Paulo, southeastern Brazil. The influence of the rainfall time series, roof area, potable water demand and percentage rainwater demand on the potential for potable water savings was evaluated. The potential for potable water savings was estimated using computer simulations considering a set of long-term rainfall time series and different sets of short-term rainfall time series. The ideal rainwater tank capacity was also assessed for some cases. It was observed that the higher the percentage rainwater demand and the shorter the rainfall time series, the larger the difference between the potential for potable water savings and the greater the variation in the ideal rainwater tank size. The sets of short-term rainfall time series considered adequate for different scenarios ranged from 1 to 13 years depending on the roof area, percentage rainwater demand and potable water demand. The main finding of the research is that sets of short-term rainfall time series can be used to assess the potential for potable water savings by using rainwater, as the results obtained are similar to those obtained from the long-term rainfall time series. Copyright © 2012 Elsevier Ltd. All rights reserved.

Leyla loop: a time-saving suture technique for robotic atrial closure

PubMed Central

Kılıç, Leyla; Şenay, Şahin; Ümit Güllü, A.; Alhan, Cem

2013-01-01

The longer durations of cardiopulmonary bypass and aortic cross-clamp times remain the disadvantages of robotic or minimally invasive cardiac surgery. For this reason, every small contribution to speeding up these procedures is of the utmost importance. Here, we present a practical, easy and time-saving suture technique for atrial closure. It consists of a hand-made loop at one end of the suture and saves the time otherwise consumed by knotting. It may also be used during conventional or minimally invasive cardiac surgery. PMID:23760357

Environmental impacts of divorce

PubMed Central

Yu, Eunice; Liu, Jianguo

2007-01-01

Divorce is increasingly common around the world. Its causes, dynamics, and socioeconomic impacts have been widely studied, but little research has addressed its environmental impacts. We found that average household size (number of people in a household) in divorced households (households with divorced heads) was 27–41% smaller than married households (households with married heads) in 12 countries across the world around the year 2000 (between 1998 and 2002). If divorced households had combined to have the same average household size as married households, there could have been 7.4 million fewer households in these countries. Meanwhile, the number of rooms per person in divorced households was 33–95% greater than in married households. In the United States (U.S.) in 2005, divorced households spent 46% and 56% more on electricity and water per person than married households. Divorced households in the U.S. could have saved more than 38 million rooms, 73 billion kilowatt-hours of electricity, and 627 billion gallons of water in 2005 alone if their resource-use efficiency had been comparable to married households. Furthermore, U.S. households that experienced divorce used 42–61% more resources per person than before their dissolution. Remarriage of divorced household heads increased household size and reduced resource use to levels similar to those of married households. The results suggest that mitigating the impacts of resource-inefficient lifestyles such as divorce helps to achieve global environmental sustainability and saves money for households. PMID:18077392

The financial impact of robotic technology for partial and radical nephrectomy.

PubMed

Kates, Max; Ball, Mark W; Patel, Hiten D; Gorin, Michael A; Pierorazio, Phillip M; Allaf, Mohamad E

2015-03-01

We sought to evaluate the financial impact of robotic technology for partial nephrectomy (PN) and radical nephrectomy (RN) in the state of Maryland. The Maryland Health Services Cost Review Commission (HSCRC) documents all acute care hospital charges data. This database was queried for patients who underwent laparoscopic or robot-assisted RN and PN from 2008 to 2012. Total hospital charge, subcharge, and length of stay (LOS) were analyzed separately for RN and PN. Overall, 2834 patients were identified. Of those, 282 were laparoscopic PN (LPN), 1078 robot-assisted PN (RPN), 1098 laparoscopic RN (LRN), and 376 robot-assisted RN (RRN). For PN, the total hospital charge was $19,062 for LPN and $18,255 for RPN (P=0.138), with a charge savings of $807 per case in favor of robotics. For RN, the total hospital charge was $23,391 for RRN and $18,280 for LRN (P=0.004), with a charge premium of $5111 for robotic cases. LOS was shorter for RPN compared with LPN (2.51 vs 2.99 days, P<0.0001) and for RRN compared with LRN (3.52 vs 3.98, P=0.0498). RPN is associated with lower hospital charges than LPN, while RRN is associated with higher hospital charges than LRN. Savings for RPN are driven by decreased room and board charge, while the premium for RRN is driven by higher operating room and supply charges. Because RRN use is increasing, the financial implications of RRN use for routine cases warrants further study.

[Cost-benefit analysis of the implementation of automated drug-dispensing systems in Critical Care and Emergency Units].

PubMed

Poveda Andrés, J L; García Gómez, C; Hernández Sansalvador, M; Valladolid Walsh, A

2003-01-01

To determine monetary impact when traditional drug floor stocks are replaced by Automated Drug Dispensing Systems (ADDS) in the Medical Intensive Care Unit, Surgical Intensive Care Unit and the Emergency Room. We analysed four different flows considered to be determinant when implementing ADDS in a hospital environment: capital investment, staff costs, inventory costs and costs related to drug use policies. Costs were estimated by calculation of the current net value. Its analysis shows that those expenses derived from initial investment are compensated by the three remaining flows, with costs related to drug use policies showing the most substantial savings. Five years after initial investment, global cash-flows have been estimated at 300.525 euros. Replacement of traditional floor stocks by ADDS in the Medical Intensive Care Unit, Surgery Intensive Care Unit and the Emergency Room produces a positive benefit/cost ratio (1.95).

Annual Energy Savings and Thermal Comfort of Autonomously Heated and Cooled Office Chairs

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

Carmichael, Scott; Booten, Chuck; Robertson, Joseph

Energy use in offices buildings is largely driven by air conditioning demands. But the optimal temperature is not the same for all building occupants, leading to the infamous thermostat war. And many occupants have independently overcome building comfort weaknesses with their own space heaters or fans. NREL tested is a customized office chair that automatically heats and cools the occupant along the seat and chair back according to the occupants' personal preferences. This product is shown to deliver markedly better comfort at room temperatures well above typical office cooling setpoints. Experimental subjects reported satisfaction in these elevated air temperatures, partlymore » because the chair's cooling effect was tuned to their own individual needs. Simulation of the chair in office buildings around the U.S. shows that energy can be saved everywhere, with impacts varying due to the climate. Total building HVAC energy savings exceeded 10% in hot-dry climate zones. Due to high product cost, simple payback for the chair we studied is beyond the expected chair life. We then understood the need to establish cost-performance targets for comfort delivery packages. NREL derived several hypothetical energy/cost/comfort targets for personal comfort product systems. In some climate regions around the U.S., these show the potential for office building HVAC energy savings in excess of 20%. This report documents this research, providing an overview of the research team's methods and results while also identifying areas for future research building upon the findings.« less

Temperature-controlled airflow ventilation in operating rooms compared with laminar airflow and turbulent mixed airflow.

PubMed

Alsved, M; Civilis, A; Ekolind, P; Tammelin, A; Andersson, A Erichsen; Jakobsson, J; Svensson, T; Ramstorp, M; Sadrizadeh, S; Larsson, P-A; Bohgard, M; Šantl-Temkiv, T; Löndahl, J

2018-02-01

To evaluate three types of ventilation systems for operating rooms with respect to air cleanliness [in colony-forming units (cfu/m 3 )], energy consumption and comfort of working environment (noise and draught) as reported by surgical team members. Two commonly used ventilation systems, vertical laminar airflow (LAF) and turbulent mixed airflow (TMA), were compared with a newly developed ventilation technique, temperature-controlled airflow (T c AF). The cfu concentrations were measured at three locations in an operating room during 45 orthopaedic procedures: close to the wound (<40cm), at the instrument table and peripherally in the room. The operating team evaluated the comfort of the working environment by answering a questionnaire. LAF and T c AF, but not TMA, resulted in less than 10cfu/m 3 at all measurement locations in the room during surgery. Median values of cfu/m 3 close to the wound (250 samples) were 0 for LAF, 1 for T c AF and 10 for TMA. Peripherally in the room, the cfu concentrations were lowest for T c AF. The cfu concentrations did not scale proportionally with airflow rates. Compared with LAF, the power consumption of T c AF was 28% lower and there was significantly less disturbance from noise and draught. T c AF and LAF remove bacteria more efficiently from the air than TMA, especially close to the wound and at the instrument table. Like LAF, the new T c AF ventilation system maintained very low levels of cfu in the air, but T c AF used substantially less energy and provided a more comfortable working environment than LAF. This enables energy savings with preserved air quality. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

I-SAVE: AN INTERACTIVE REAL-TIME MONITOR AND CONTROLLER TO INFLUENCE ENERGY CONSERVATION BEHAVIOR BY IMPULSE SAVING

EPA Science Inventory

Simulation-based model to explore the benefits of monitoring and control to energy saving opportunities in residential homes; an adaptive algorithm to predict the type of electrical loads; a prototype user friendly interface monitoring and control device to save energy; a p...

Improving value of travel time savings estimation for more effective transportation project evaluation.

DOT National Transportation Integrated Search

2012-12-01

Estimates of value of time (VOT) and value of travel time savings (VTTS) are critical elements in benefitcost : analyses of transportation projects and in developing congestion pricing policies. In addition, : differences in VTTS among various modes ...

Application of automated measurement and verification to utility energy efficiency program data

DOE PAGES

Granderson, Jessica; Touzani, Samir; Fernandes, Samuel; ...

2017-02-17

Trustworthy savings calculations are critical to convincing regulators of both the cost-effectiveness of energy efficiency program investments and their ability to defer supply-side capital investments. Today’s methods for measurement and verification (M&V) of energy savings constitute a significant portion of the total costs of energy efficiency programs. They also require time-consuming data acquisition. A spectrum of savings calculation approaches is used, with some relying more heavily on measured data and others relying more heavily on estimated, modeled, or stipulated data. The increasing availability of “smart” meters and devices that report near-real time data, combined with new analytical approaches to quantifymore » savings, offers the potential to conduct M&V more quickly and at lower cost, with comparable or improved accuracy. Commercial energy management and information systems (EMIS) technologies are beginning to offer these ‘M&V 2.0’ capabilities, and program administrators want to understand how they might assist programs in quickly and accurately measuring energy savings. This paper presents the results of recent testing of the ability to use automation to streamline the M&V process. In this paper, we apply an automated whole-building M&V tool to historic data sets from energy efficiency programs to begin to explore the accuracy, cost, and time trade-offs between more traditional M&V, and these emerging streamlined methods that use high-resolution energy data and automated computational intelligence. For the data sets studied we evaluate the fraction of buildings that are well suited to automated baseline characterization, the uncertainty in gross savings that is due to M&V 2.0 tools’ model error, and indications of labor time savings, and how the automated savings results compare to prior, traditionally determined savings results. The results show that 70% of the buildings were well suited to the automated approach. In a majority of the cases (80%) savings and uncertainties for each individual building were quantified to levels above the criteria in ASHRAE Guideline 14. In addition the findings suggest that M&V 2.0 methods may also offer time-savings relative to traditional approaches. Lastly, we discuss the implications of these findings relative to the potential evolution of M&V, and pilots currently being launched to test how M&V automation can be integrated into ratepayer-funded programs and professional implementation and evaluation practice.« less

Application of automated measurement and verification to utility energy efficiency program data

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

Granderson, Jessica; Touzani, Samir; Fernandes, Samuel

Trustworthy savings calculations are critical to convincing regulators of both the cost-effectiveness of energy efficiency program investments and their ability to defer supply-side capital investments. Today’s methods for measurement and verification (M&V) of energy savings constitute a significant portion of the total costs of energy efficiency programs. They also require time-consuming data acquisition. A spectrum of savings calculation approaches is used, with some relying more heavily on measured data and others relying more heavily on estimated, modeled, or stipulated data. The increasing availability of “smart” meters and devices that report near-real time data, combined with new analytical approaches to quantifymore » savings, offers the potential to conduct M&V more quickly and at lower cost, with comparable or improved accuracy. Commercial energy management and information systems (EMIS) technologies are beginning to offer these ‘M&V 2.0’ capabilities, and program administrators want to understand how they might assist programs in quickly and accurately measuring energy savings. This paper presents the results of recent testing of the ability to use automation to streamline the M&V process. In this paper, we apply an automated whole-building M&V tool to historic data sets from energy efficiency programs to begin to explore the accuracy, cost, and time trade-offs between more traditional M&V, and these emerging streamlined methods that use high-resolution energy data and automated computational intelligence. For the data sets studied we evaluate the fraction of buildings that are well suited to automated baseline characterization, the uncertainty in gross savings that is due to M&V 2.0 tools’ model error, and indications of labor time savings, and how the automated savings results compare to prior, traditionally determined savings results. The results show that 70% of the buildings were well suited to the automated approach. In a majority of the cases (80%) savings and uncertainties for each individual building were quantified to levels above the criteria in ASHRAE Guideline 14. In addition the findings suggest that M&V 2.0 methods may also offer time-savings relative to traditional approaches. Lastly, we discuss the implications of these findings relative to the potential evolution of M&V, and pilots currently being launched to test how M&V automation can be integrated into ratepayer-funded programs and professional implementation and evaluation practice.« less

Time-varying value of electric energy efficiency

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

Mims, Natalie A.; Eckman, Tom; Goldman, Charles

Electric energy efficiency resources save energy and may reduce peak demand. Historically, quantification of energy efficiency benefits has largely focused on the economic value of energy savings during the first year and lifetime of the installed measures. Due in part to the lack of publicly available research on end-use load shapes (i.e., the hourly or seasonal timing of electricity savings) and energy savings shapes, consideration of the impact of energy efficiency on peak demand reduction (i.e., capacity savings) has been more limited. End-use load research and the hourly valuation of efficiency savings are used for a variety of electricity planningmore » functions, including load forecasting, demand-side management and evaluation, capacity and demand response planning, long-term resource planning, renewable energy integration, assessing potential grid modernization investments, establishing rates and pricing, and customer service. This study reviews existing literature on the time-varying value of energy efficiency savings, provides examples in four geographically diverse locations of how consideration of the time-varying value of efficiency savings impacts the calculation of power system benefits, and identifies future research needs to enhance the consideration of the time-varying value of energy efficiency in cost-effectiveness screening analysis. Findings from this study include: -The time-varying value of individual energy efficiency measures varies across the locations studied because of the physical and operational characteristics of the individual utility system (e.g., summer or winter peaking, load factor, reserve margin) as well as the time periods during which savings from measures occur. -Across the four locations studied, some of the largest capacity benefits from energy efficiency are derived from the deferral of transmission and distribution system infrastructure upgrades. However, the deferred cost of such upgrades also exhibited the greatest range in value of all the components of avoided costs across the locations studied. -Of the five energy efficiency measures studied, those targeting residential air conditioning in summer-peaking electric systems have the most significant added value when the total time-varying value is considered. -The increased use of rooftop solar systems, storage, and demand response, and the addition of electric vehicles and other major new electricity-consuming end uses are anticipated to significantly alter the load shape of many utility systems in the future. Data used to estimate the impact of energy efficiency measures on electric system peak demands will need to be updated periodically to accurately reflect the value of savings as system load shapes change. -Publicly available components of electric system costs avoided through energy efficiency are not uniform across states and utilities. Inclusion or exclusion of these components and differences in their value affect estimates of the time-varying value of energy efficiency. -Publicly available data on end-use load and energy savings shapes are limited, are concentrated regionally, and should be expanded.« less

Efficient Kill-Save Ratios Ease Up the Cognitive Demands on Counterintuitive Moral Utilitarianism.

PubMed

Trémolière, Bastien; Bonnefon, Jean-François

2014-07-01

The dual-process model of moral judgment postulates that utilitarian responses to moral dilemmas (e.g., accepting to kill one to save five) are demanding of cognitive resources. Here we show that utilitarian responses can become effortless, even when they involve to kill someone, as long as the kill-save ratio is efficient (e.g., 1 is killed to save 500). In Experiment 1, participants responded to moral dilemmas featuring different kill-save ratios under high or low cognitive load. In Experiments 2 and 3, participants responded at their own pace or under time pressure. Efficient kill-save ratios promoted utilitarian responding and neutered the effect of load or time pressure. We discuss whether this effect is more easily explained by a parallel-activation model or by a default-interventionist model. © 2014 by the Society for Personality and Social Psychology, Inc.

31 CFR 351.6 - When may I redeem my Series EE savings bond?

Code of Federal Regulations, 2014 CFR

2014-07-01

... before January 1, 2003. You may redeem your Series EE savings bond at any time beginning six months after... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false When may I redeem my Series EE... SAVINGS BONDS, SERIES EE Maturities, Redemption Values, and Investment Yields of Series EE Savings Bonds...

31 CFR 351.6 - When may I redeem my Series EE savings bond?

Code of Federal Regulations, 2010 CFR

2010-07-01

... before January 1, 2003. You may redeem your Series EE savings bond at any time beginning six months after... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false When may I redeem my Series EE... SAVINGS BONDS, SERIES EE Maturities, Redemption Values, and Investment Yields of Series EE Savings Bonds...

47 CFR 73.99 - Presunrise service authorization (PSRA) and postsunset service authorization (PSSA).

Code of Federal Regulations, 2013 CFR

2013-10-01

... authorization. (c) Extended Daylight Saving Time Pre-Sunrise Authorizations: (1) Between the first Sunday in... presunrise operations during extended daylight saving time and shall issue conforming authorizations. These...

47 CFR 73.99 - Presunrise service authorization (PSRA) and postsunset service authorization (PSSA).

Code of Federal Regulations, 2011 CFR

2011-10-01

... authorization. (c) Extended Daylight Saving Time Pre-Sunrise Authorizations: (1) Between the first Sunday in... presunrise operations during extended daylight saving time and shall issue conforming authorizations. These...

Roll-to-roll Slot-die Printed Polymer Solar Cell by Self-Assembly.

PubMed

Yang, Junyu; Lin, Yuanbao; Zheng, Wenhao; Liu, Alei; Cai, Wanzhu; Yu, Xiaomin; Zhang, Fengling; Liang, Quanbin; Wu, Hongbin; Qin, Donghuan; Hou, Lintao

2018-06-12

Extremely simplified one-step roll-to-roll slot-die printed flexible ITO-free polymer solar cells (PSCs) are demonstrated based on ternary blends of electron-donor polymer thieno [3,4-b]thiophene/benzodithiophene (PTB7), electron-acceptor fullerene [6,6]-phenyl-C71-butyric acid methyl ester (PC71BM) and electron extracting polymer poly [(9,9-bis(3'-(N,N-dimethylamino)propyl)-2,7-fluorene)-alt-2,7-(9,9-dioctylfluorene)] (PFN) at room temperature (RT) in ambient air. The flexible ITO-free PSC exhibits a comparable power conversion efficiency (PCE) with the device employing complicated two-step slot-die printing (5.29% vs 5.41%), which indicates that PFN molecules can migrate from the ternary nanocomposite towards Ag cathode via vertical self-assembly during the one-step slot-die printing process in air. To confirm the migration of PFN, the morphology and elemental analysis as well as charge transport of different active layers are investigated with in-situ transient film drying process, transmission electron microscopy, atomic force microscopy, contact angle and surface energy, X-ray photoelectron spectroscopy, scanning electron microscope, impedance spectroscopy, transient photovoltage and transient photocurrent as well as laser beam induced current. Moreover, the good air and mechanical stability of the flexible device with a decent PCE achieved in 1 cm2 PSCs at RT in air suggests the feasibility of energy-saving and time-saving one-step slot-die printing to large-scale roll-to-roll manufacture in the future.

Estimated financial savings associated with health information exchange and ambulatory care referral.

PubMed

Frisse, Mark E; Holmes, Rodney L

2007-12-01

Data and financial models based on an operational health information exchange suggest that health care delivery costs can be reduced by making clinical data available at the time of care in urban emergency departments. Reductions are the result of decreases in laboratory and radiographic tests, fewer admissions for observation, and lower overall emergency department costs. The likelihood of reducing these costs depends on the extent to which clinicians alter their workflow and take into account information available through the exchange from other institutions prior to initiating a treatment plan. Far greater savings can be realized in theory by identifying individuals presenting to emergency departments whose acute and long-term care needs are more suitably addressed at lower costs in ambulatory settings or medical homes. These alternative ambulatory settings can more effectively address the chronic care needs of those who receive most of their care in emergency departments. To support a shift from emergency room care to clinic care, health care information available through the health information exchange must be made available in both emergency department and ambulatory care settings. If practice workflow and patient behavior can be changed, a more effective and efficient care delivery system will be made possible through the secure exchange of clinical information across regional settings. These projections support the case for the financial viability of regional health information exchanges and motivate participation of hospitals and ambulatory care organizations-particularly in urban settings.

Factors determining the smooth flow and the non-operative time in a one-induction room to one-operating room setting

PubMed Central

Mulier, Jan P; De Boeck, Liesje; Meulders, Michel; Beliën, Jeroen; Colpaert, Jan; Sels, Annabel

2015-01-01

Rationale, aims and objectives What factors determine the use of an anaesthesia preparation room and shorten non-operative time? Methods A logistic regression is applied to 18 751 surgery records from AZ Sint-Jan Brugge AV, Belgium, where each operating room has its own anaesthesia preparation room. Surgeries, in which the patient's induction has already started when the preceding patient's surgery has ended, belong to a first group where the preparation room is used as an induction room. Surgeries not fulfilling this property belong to a second group. A logistic regression model tries to predict the probability that a surgery will be classified into a specific group. Non-operative time is calculated as the time between end of the previous surgery and incision of the next surgery. A log-linear regression of this non-operative time is performed. Results It was found that switches in surgeons, being a non-elective surgery as well as the previous surgery being non-elective, increase the probability of being classified into the second group. Only a few surgery types, anaesthesiologists and operating rooms can be found exclusively in one of the two groups. Analysis of variance demonstrates that the first group has significantly lower non-operative times. Switches in surgeons, anaesthesiologists and longer scheduled durations of the previous surgery increases the non-operative time. A switch in both surgeon and anaesthesiologist strengthens this negative effect. Only a few operating rooms and surgery types influence the non-operative time. Conclusion The use of the anaesthesia preparation room shortens the non-operative time and is determined by several human and structural factors. PMID:25496600

Demonstration testing of a surveillance robot at Browns Ferry Nuclear Plant: Analysis of costs and benefits

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

White, J.R.; Farnstrom, K.A.; Harvey, H.W.

1987-03-01

This report presents the results of an NRC project to determine whether robotics equipment can be cost effective in performing surveillance and inspection work at existing nuclear power plants. A mobile surveillance robot, called SURBOT, was developed by the Remote Technology Corporation (REMOTEC) to perform visual, sound, and radiation surveillance within rooms designated as radiologically hazardous. SURBOT was tested in the turbine building of the Browns Ferry Nuclear Plant (BFNP) by TVA personnel for a five-month period. The results showed that SURBOT obtains higher quality data and can perform more thorough surveillance within radiation areas than workers wearing protective clothing.more » SURBOT can be transferred between rooms without releasing contamination in the hallways using a portable enclosure. TVA has estimated that over 100 person-rem exposure and $100,000 operating costs can be saved annually at the BFNP using SURBOT for surveillance in 54 turbine and reactor building rooms. TVA recommendations for improving the function, reliability, and maintainability have been incorporated into a production model of SURBOT which is now commercially available from REMOTEC along with other types of mobile robots and manipulators.« less

Chapter 19: HVAC Controls (DDC/EMS/BAS) Evaluation Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

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

Kurnik, Charles W.; Romberger, Jeff

The HVAC Controls Evaluation Protocol is designed to address evaluation issues for direct digital controls/energy management systems/building automation systems (DDC/EMS/BAS) that are installed to control heating, ventilation, and air-conditioning (HVAC) equipment in commercial and institutional buildings. (This chapter refers to the DDC/EMS/BAS measure as HVAC controls.) This protocol may also be applicable to industrial facilities such as clean rooms and labs, which have either significant HVAC equipment or spaces requiring special environmental conditions.

Soviet News and Propaganda Highlights from Red Star (The Official Newspaper of the Soviet Defense Establishment) for the Period 1-30 June 1981.

DTIC Science & Technology

1981-06-01

may be obtained by contacting the Joint Chiefs of Staff - Special Operations Division (JCS-SOD), Pentagon Room * Number 2C839 or by calling 697-3455...Russia saved Europe from Nazism. A secondary propaganda focus was an international appeal (by the Kremlin) for world peace and disarmament. A number of...feature stories emphasized that experiences from World War II must be taught to the current generation of soldiers . E-2 Ir The major emphasis of issues

A comprehensive operating room information system using the Kinect sensors and RFID.

PubMed

Nouei, Mahyar Taghizadeh; Kamyad, Ali Vahidian; Soroush, Ahmad Reza; Ghazalbash, Somayeh

2015-04-01

Occasionally, surgeons do need various types of information to be available rapidly, efficiently and safely during surgical procedures. Meanwhile, they need to free up hands throughout the surgery to necessarily access the mouse to control any application in the sterility mode. In addition, they are required to record audio as well as video files, and enter and save some data. This is an attempt to develop a comprehensive operating room information system called "Medinav" to tackle all mentioned issues. An integrated and comprehensive operating room information system is introduced to be compatible with Health Level 7 (HL7) and digital imaging and communications in medicine (DICOM). DICOM is a standard for handling, storing, printing, and transmitting information in medical imaging. Besides, a natural user interface (NUI) is designed specifically for operating rooms where touch-less interactions with finger and hand tracking are in use. Further, the system could both record procedural data automatically, and view acquired information from multiple perspectives graphically. A prototype system is tested in a live operating room environment at an Iranian teaching hospital. There are also contextual interviews and usability satisfaction questionnaires conducted with the "MediNav" system to investigate how useful the proposed system could be. The results reveal that integration of these systems into a complete solution is the key to not only stream up data and workflow but maximize surgical team usefulness as well. It is now possible to comprehensively collect and visualize medical information, and access a management tool with a touch-less NUI in a rather quick, practical, and harmless manner.

Operating room efficiency improvement after implementation of a postoperative team assessment.

PubMed

Porta, Christopher R; Foster, Andrew; Causey, Marlin W; Cordier, Patricia; Ozbirn, Roger; Bolt, Stephen; Allison, Dennis; Rush, Robert

2013-03-01

Operating room time is highly resource intensive, and delays can be a source of lost revenue and surgeon frustration. Methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization. The purpose of this study was to determine the root cause of operating room delays in a standardized manner to help improve overall operating room efficiency. We performed a single-center prospective observational study analyzing operating room utilization and efficiency after implementing an executive-driven standardized postoperative team debriefing system from January 2010 to December 2010. A total of 11,342 procedures were performed over the 1-y study period (elective 86%, urgent 11%, and emergent 3%), with 1.3 million min of operating room time, 865,864 min of surgeon operative time (62.5%), and 162,958 min of anesthesia time (11.8%). Overall, the average operating room delay was 18 min and varied greatly based on the surgical specialty. The longest delays were due to need for radiology (40 min); other significant delays were due to supply issues (22.7 min), surgeon issues (18 min), nursing issues (14 min), and room turnover (14 min). Over the 1-y period, there was a decrease in mean delay duration, averaging a decrease in delay of 0.147 min/mo with an overall 9% decrease in the mean delay times. With regard to overall operating room utilization, there was a 39% decrease in overall un-utilized available OR time that was due to delays, improving efficiency by 2334 min (212 min/mo). During this study interval no sentinel events occurred in the operating room. A standardized postoperative debrief tracking system is highly beneficial in identifying and reducing overall operative delays and improving operating room utilization. Published by Elsevier Inc.

Governing time in operating rooms.

PubMed

Riley, Robin; Manias, Elizabeth

2006-05-01

This paper examines how time is controlled and governed in operating rooms through interpersonal communication between nurses and doctors. Time is a valuable commodity in organizations with improvements often directed towards maximizing efficiencies. As a consequence, time can be a source of tension and interpersonal conflict as individuals compete for control of its use. The data in this paper emanate from an ethnographic study that explored a range of communication practices in operating room nursing. Participants comprised 11 operating room nurses. Data were collected over two years in three different institutional settings and involved participant observation, interviews and the keeping of a personal diary. A deconstructive analysis of the data was undertaken. Results are discussed in terms of the practices, in which clinicians are engaged in, to govern and control their use of time. The four practices presented in this paper include; questioning judgment and timing, controlling speed, estimating surgeons' use of time and coping with different perceptions of time. Time and speed were hotly contested by nurses. They used their personal knowledge of individual surgeon's habits of time to govern and control practice. Nurses thought about surgeons in terms of time and developed commonly accepted understandings about the length of surgical procedures. They used this knowledge to manage the scheduling of operations in the departments and to control the workflow in individual operating rooms. Knowledge of individual surgeons was a source of power for operating room nurses. Nurses have more power in the operating room than might be imagined but they exercise this power in subtle ways. If operating rooms are to work effectively, the operating room team must understand each others' work better.

Travelers’ Value of Time and Reliability as Measured on Katy Freeway : Final Report.

DOT National Transportation Integrated Search

2016-09-01

The value of travel time savings (VOT) is an estimate of what travelers would be willing to pay in order to save time on a particular trip. If travelers would pay $1 to reduce their travel time by six minutes, then they have a VOT of $10 per hour. VO...

Supermarket refrigeration assessment for the Commonwealth Electric Company

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

Tsaros, T.L.; Walker, D.H.

The Commonwealth Electric Company (COM/Electric) has initiated an incentive program to promote electric energy conservation within its service territory. The Electric Power Research Institute (EPRI) has assisted COM/Electric in assessing the impact on the utility and its customers of implementing energy efficient supermarket refrigeration in retrofit applications. The primary task of this assessment was to contact the supermarket chains and refrigeration contractors and suppliers in the COM/Electric service territory to determine the type of refrigeration employed and standard or novel retrofit equipment implemented in supermarkets. With this information, estimates were made of the potential energy savings that COM/Electric and themore » supermarkets could realize if supermarkets were retrofitted with energy efficient refrigeration equipment. It was determined that the refrigerated display case features offering the greatest potential for savings through retrofit installations include doors for medium temperature multideck cases, high-efficiency fan motors, anti-sweat heater controls, and vinyl strip curtains for walk-in coolers. The retrofit components associated with the compressor machine room that offer the greatest potential for savings include the use of low heat pressure control, hot gas defrost, and external liquid-suction heat exchangers and remote evaporative subcoolers for low temperature refrigeration. 6 refs., 14 figs., 26 tabs.« less

Analysis of wallboard containing a phase change material

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

Tomlinson, J.J.; Heberle, D.P.

1990-01-01

Phase change materials (PCMs) used on the interior of buildings hold the promise for improved thermal performance by reducing the energy requirements for space conditioning and by improving thermal comfort by reducing temperature swings inside the building. Efforts are underway to develop a gypsum wallboard containing a hydrocarbon PCM. With a phase change temperature in the room temperature range, the PCM wallboard adds substantially to the thermal mass of the building while serving the same architectural function as conventional wallboard. To determine the thermal and economic performance of this PCM wallboard, the Transient Systems Simulation Program (TRNSYS) was modified tomore » accommodate walls that are covered with PCM plasterboard, nd to apportion the direct beam solar radiation to interior surfaces of a building. The modified code was used to simulate the performance of conventional and direct-gain passive solar residential-sized buildings with and without PCM wallboard. Space heating energy savings were determined as a function of PCM wallboard characteristics. Thermal comfort improvements in buildings containing the PCM were qualified in terms of energy savings. The report concludes with a present worth economic analysis of these energy savings and arrives at system costs and economic payback based on current costs of PCMs under study for the wallboard application. 5 refs., 4 figs., 4 tabs.« less

Delay Analysis of GTS Bridging between IEEE 802.15.4 and IEEE 802.11 Networks for Healthcare Applications

PubMed Central

Mišić, Jelena; (Sherman) Shen, Xuemin

2009-01-01

We consider interconnection of IEEE 802.15.4 beacon-enabled network cluster with IEEE 802.11b network. This scenario is important in healthcare applications where IEEE 802.15.4 nodes comprise patient's body area network (BAN) and are involved in sensing some health-related data. BAN nodes have very short communication range in order to avoid harming patient's health and save energy. Sensed data needs to be transmitted to an access point in the ward room using wireless technology with higher transmission range and rate such as IEEE 802.11b. We model the interconnected network where IEEE 802.15.4-based BAN operates in guaranteed time slot (GTS) mode, and IEEE 802.11b part of the bridge conveys GTS superframe to the 802.11b access point. We then analyze the network delays. Performance analysis is performed using EKG traffic from continuous telemetry, and we discuss the delays of communication due the increasing number of patients. PMID:19107184

Appropriate and inappropriate uses of classroom amplification

NASA Astrophysics Data System (ADS)

Lubman, David; Sutherland, Louis C.

2005-09-01

Currently, classroom amplifiers are being aggressively advocated as substitutes for good acoustics in small mainstream classrooms. Amplifiers are routinely installed without regard to unoccupied classroom noise levels and reverberation times. Amplifiers are being specified by some school districts as a money-saving alternative to mandating compliance with the ANSI standard on classroom acoustics, S12.60-2002. Manufacturers of portable classrooms and noisy wall mounted HVAC systems have joined in supporting the use of classroom amplifiers, claiming that low (35 dBA) classroom noise levels specified by the ANSI standard are unaffordable and unnecessary given amplifiers. The authors believe that the routine use of classroom amplification is appropriate in very large lecture rooms, in special education classrooms for hearing impaired students, for voice-impaired occupants, and perhaps in certain other limited circumstances. The authors explain why they believe the routine use of amplifiers in small mainstream classrooms is an inappropriate substitute for the good classroom acoustics specified in the ANSI standard.

Delay Analysis of GTS Bridging between IEEE 802.15.4 and IEEE 802.11 Networks for Healthcare Applications.

PubMed

Misić, Jelena; Sherman Shen, Xuemin

2009-01-01

We consider interconnection of IEEE 802.15.4 beacon-enabled network cluster with IEEE 802.11b network. This scenario is important in healthcare applications where IEEE 802.15.4 nodes comprise patient's body area network (BAN) and are involved in sensing some health-related data. BAN nodes have very short communication range in order to avoid harming patient's health and save energy. Sensed data needs to be transmitted to an access point in the ward room using wireless technology with higher transmission range and rate such as IEEE 802.11b. We model the interconnected network where IEEE 802.15.4-based BAN operates in guaranteed time slot (GTS) mode, and IEEE 802.11b part of the bridge conveys GTS superframe to the 802.11b access point. We then analyze the network delays. Performance analysis is performed using EKG traffic from continuous telemetry, and we discuss the delays of communication due the increasing number of patients.

Testing an Asset-Building Approach for Young People: Early Access to Savings Predicts Later Savings

ERIC Educational Resources Information Center

Friedline, Terri; Elliott, William; Chowa, Gina A. N.

2013-01-01

A major hypothesis of asset-building is that early access to savings accounts leads to continued and improved educational and economic outcomes over time. This study asks whether or not young adults (ages 18-22) in 2007, particularly among lower income households, are significantly more likely to own savings accounts and to accumulate more savings…

Detection of respiratory viruses and bacteria in children using a twenty-two target reverse-transcription real-time PCR (RT-qPCR) panel.

PubMed

Ellis, Chelsey; Misir, Amita; Hui, Charles; Jabbour, Mona; Barrowman, Nicholas; Langill, Jonathan; Bowes, Jennifer; Slinger, Robert

2016-05-01

Rapid detection of the wide range of viruses and bacteria that cause respiratory infection in children is important for patient care and antibiotic stewardship. We therefore designed and evaluated a ready-to-use 22 target respiratory infection reverse-transcription real-time polymerase chain reaction (RT-qPCR) panel to determine if this would improve detection of these agents at our pediatric hospital. RT-qPCR assays for twenty-two target organisms were dried-down in individual wells of 96 well plates and saved at room temperature. Targets included 18 respiratory viruses and 4 bacteria. After automated nucleic acid extraction of nasopharyngeal aspirate (NPA) samples, rapid qPCR was performed. RT-qPCR results were compared with those obtained by the testing methods used at our hospital laboratories. One hundred fifty-nine pediatric NPA samples were tested with the RT-qPCR panel. One or more respiratory pathogens were detected in 132/159 (83%) samples. This was significantly higher than the detection rate of standard methods (94/159, 59%) (P<0.001). This difference was mainly due to improved RT-qPCR detection of rhinoviruses, parainfluenza viruses, bocavirus, and coronaviruses. The panel internal control assay performance remained stable at room temperature storage over a two-month testing period. The RT-qPCR panel was able to identify pathogens in a high proportion of respiratory samples. The panel detected more positive specimens than the methods in use at our hospital. The pre-made panel format was easy to use and rapid, with results available in approximately 90 minutes. We now plan to determine if use of this panel improves patient care and antibiotic stewardship.

Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays.

PubMed

Stockert, Emily Walker; Langerman, Alexander

2014-10-01

Efficiency in the operating room has become a topic of great interest. This study aimed to quantify the percent use of instruments among common instrument trays across 4 busy surgical services: Otolaryngology, Plastic Surgery, Bariatric Surgery, and Neurosurgery. We further aimed to calculate the costs associated with tray and instrument sterilization, as well as the implications of missing or damaged instruments. This was a single-site, observational study conducted on the surgical instrumentation at a large academic medical center in Chicago. Data were collected through direct observation by a trained investigator. Operating room instrument use and labor time required for cleaning and repacking instrument trays in central sterile processing (CSP) were analyzed using descriptive statistics and linear regression. Institutional data on volume and expenses were gathered from hospital leadership. Forty-nine procedures and 237 individual trays were observed. Average instrument (±SD)use rates were 13.0% for Otolaryngology (±4.2%), 15.5% for Plastic Surgery (±2.9%), 18.2% for Bariatric Surgery (±5.0%), and 21.9% for Neurosurgery (±1.7%). An increasing number of instruments per tray was associated with decreased use and increased instrument error rate. Using recorded labor time, the cost of cleaning and repackaging an individual instrument was calculated to be $0.10. Adding in CSP operating expenses and instrument depreciation per use, total processing cost per instrument increases to $0.51 or more. Our study demonstrates that the percent use of instruments across surgical specialties and multiple tray types is low. Attention to tray composition may result in immediate and significant cost savings. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

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

Mobile based Appliances switching using Bluetooth

NASA Astrophysics Data System (ADS)

Gupta, Sureshchandra J., Dr; Desai, Kalp; Gaikawad, Deepak; Pawar, Vijay N.; Gangal, Devendranath R.

2008-04-01

How many times do you have to get up from your desk to switch on your Air conditioner or fan when you are completely into your table work? How many times do you feel lazy to get off your comfort to switch on/off your home appliances in different rooms? How much energy do you lose in a day for operating your appliances? The solution is either a large amount of manual work—or the idea that is presented over here: APP-CON (APP-CON stands for appliances control). Here the ordinary cell phone with bluetooth capability acts as remote designed in such a manner that it acts as a helping hand to human by reducing its manual work and therefore saving human energy. The cell phone control of APP-CON units lets you access many of your home appliances situated in different rooms by using just a single remote from distance. Electronics hobbyists would love to make such a remote control themselves. But they find it difficult due to complex circuitry rather than the high cost because of using a number of frequency counting techniques and decade counters. The APP-CON system given here overcomes the aforesaid problems by using a single microcontroller and moreover a simple program or software for bluetooth enabled cell phone and employing simple coding and decoding of remote signals. Here the mobile based remote control is used to operate a number of home appliances basically consists of Bluetooth technology. The unit consists of a transmitter and a receiver consisting of a microcontroller. The importance of bluetooth technology is that the signal to be transmitted from transmitter to the receiver is done without requiring line of sight.

Daylight Savings Time Transitions and the Incidence Rate of Unipolar Depressive Episodes.

PubMed

Hansen, Bertel T; Sønderskov, Kim M; Hageman, Ida; Dinesen, Peter T; Østergaard, Søren D

2017-05-01

Daylight savings time transitions affect approximately 1.6 billion people worldwide. Prior studies have documented associations between daylight savings time transitions and adverse health outcomes, but it remains unknown whether they also cause an increase in the incidence rate of depressive episodes. This seems likely because daylight savings time transitions affect circadian rhythms, which are implicated in the etiology of depressive disorder. Therefore, we investigated the effects of daylight savings time transitions on the incidence rate of unipolar depressive episodes. Using time series intervention analysis of nationwide data from the Danish Psychiatric Central Research Register from 1995 to 2012, we compared the observed trend in the incidence rate of hospital contacts for unipolar depressive episodes after the transitions to and from summer time to the predicted trend in the incidence rate. The analyses were based on 185,419 hospital contacts for unipolar depression and showed that the transition from summer time to standard time were associated with an 11% increase (95% CI = 7%, 15%) in the incidence rate of unipolar depressive episodes that dissipated over approximately 10 weeks. The transition from standard time to summer time was not associated with a parallel change in the incidence rate of unipolar depressive episodes. This study shows that the transition from summer time to standard time was associated with an increase in the incidence rate of unipolar depressive episodes. Distress associated with the sudden advancement of sunset, marking the coming of a long period of short days, may explain this finding. See video abstract at, http://links.lww.com/EDE/B179.

Insights from Smart Meters: Identifying Specific Actions, Behaviors, and Characteristics That Drive Savings in Behavior-Based Programs

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

Todd, A.; Perry, M.; Smith, B.

2014-12-01

In this report, we use smart meter data to analyze specific actions, behaviors, and characteristics that drive energy savings in a BB program. Specifically, we examine a Home Energy Report (HER) program. These programs typically obtain 1% to 3% annual savings, and recent studies have shown hourly savings of between 0.5% and 3%.1 But what is driving these savings? What types of households tend to be “high-savers,” and what behaviors are they adopting? There are several possibilities: one-time behaviors (e.g., changing thermostat settings), reoccurring habitual behaviors (e.g., turning off lights), and equipment purchase behaviors (e.g., energy efficient appliances); these maymore » vary across households, regions, and over time.« less

Insights from Smart Meters. Identifying Specific Actions, Behaviors and Characteristics that drive savings in Behavior-Based Programs

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

Todd, Annika; Perry, Michael; Smith, Brian

2014-12-01

In this report, we use smart meter data to analyze specific actions, behaviors, and characteristics that drive energy savings in a behavior-based (BB) program. Specifically, we examine a Home Energy Report (HER) program. These programs typically obtain 1% to 3% annual savings, and recent studies have shown hourly savings of between 0.5% and 3%. But what is driving these savings? What types of households tend to be “high-savers”, and what behaviors are they adopting? There are several possibilities: one-time behaviors (e.g., changing thermostat settings); reoccurring habitual behaviors (e.g., turning off lights); and equipment purchase behaviors (e.g., energy efficient appliances), andmore » these may vary across households, regions, and over time.« less

Operating room metrics score card-creating a prototype for individualized feedback.

PubMed

Gabriel, Rodney A; Gimlich, Robert; Ehrenfeld, Jesse M; Urman, Richard D

2014-11-01

The balance between reducing costs and inefficiencies with that of patient safety is a challenging problem faced in the operating room suite. An ongoing challenge is the creation of effective strategies that reduce these inefficiencies and provide real-time personalized metrics and electronic feedback to anesthesia practitioners. We created a sample report card structure, utilizing existing informatics systems. This system allows to gather and analyze operating room metrics for each anesthesia provider and offer personalized feedback. To accomplish this task, we identified key metrics that represented time and quality parameters. We collected these data for individual anesthesiologists and compared performance to the overall group average. Data were presented as an electronic score card and made available to individual clinicians on a real-time basis in an effort to provide effective feedback. These metrics included number of cancelled cases, average turnover time, average time to operating room ready and patient in room, number of delayed first case starts, average induction time, average extubation time, average time to recovery room arrival to discharge, performance feedback from other providers, compliance to various protocols, and total anesthetic costs. The concept we propose can easily be generalized to a variety of operating room settings, types of facilities and OR health care professionals. Such a scorecard can be created using content that is important for operating room efficiency, research, and practice improvement for anesthesia providers.

Energy-Efficient and Comfortable Buildings through Multivariate Integrated Control (ECoMIC)

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

Birru, Dagnachew; Wen, Yao-Jung; Rubinstein, Francis M.

2013-10-28

This project aims to develop an integrated control solution for enhanced energy efficiency and user comfort in commercial buildings. The developed technology is a zone-based control framework that minimizes energy usage while maintaining occupants’ visual and thermal comfort through control of electric lights, motorized venetian blinds and thermostats. The control framework is designed following a modular, scalable and flexible architecture to facilitate easy integration with exiting building management systems. The control framework contains two key algorithms: 1) the lighting load balancing algorithm and 2) the thermostat control algorithm. The lighting load balancing algorithm adopts a model-based closed-loop control approach tomore » determine the optimal electric light and venetian blind settings. It is formulated into an optimization problem with minimizing lighting-related energy consumptions as the objective and delivering adequate task light and preventing daylight glare as the constraints. The thermostat control algorithm is based on a well-established thermal comfort model and formulated as a root-finding problem to dynamically determine the optimal thermostat setpoint for both energy savings and improved thermal comfort. To address building-wide scalability, a system architecture was developed for the zone-based control technology. Three levels of services are defined in the architecture: external services, facility level services and zone level services. The zone-level service includes the control algorithms described above as well as the corresponding interfaces, profiles, sensors and actuators to realize the zone controller. The facility level services connect to the zones through a backbone network, handle supervisory level information and controls, and thus facilitate building-wide scalability. The external services provide communication capability to entities outside of the building for grid interaction and remote access. Various aspects of the developed control technology were evaluated and verified through both simulations and testbed implementations. Simulations coupling a DOE medium office reference building in EnergyPlus building simulation software and a prototype controller in Matlab were performed. During summer time in a mixed-humid climate zone, the simulations revealed reductions of 27% and 42% in electric lighting load and cooling load, respectively, when compared to an advanced base case with daylight dimming and blinds automatically tilted to block direct sun. Two single-room testbeds were established. The testbed at Philips Lighting business building (Rosemont, IL) was designed for quantifying energy performance of integrated controls. This particular implementation achieved 40% and 79% savings on lighting and HVAC energy, respectively, compared to a relatively simple base case operated on predefined schedules. While the resulting energy savings was very encouraging, it should be noted that there may be several caveats associated with it. 1) The test was run during late spring and early summer, and the savings numbers might not be directly used to extrapolate the annual energy savings. 2) Due to the needs for separate control and metering of the small-scale demonstrator within a large building, the HVAC system, hence the corresponding savings, did not represent a typical energy code-compliant design. 3) The light level in the control case was regulated at a particular setpoint, which was lower than then the full-on light level in the base case, and the savings resulted from tuning down the light level to the setpoint was not attributable to the contribution of the developed technology. The testbed at the Lawrence Berkeley National Laboratory (Berkeley, CA) specifically focused on glare control integration, and has demonstrated the feasibility and capability of the glare detection and prevention technique. While the short one-month test in this testbed provided a functional indication of the developed technology, and it would require at least a full solstice-to-solstice cycle to ruinously quantify the performance, which was not possible within the project timeframe. There are certain limitations inherited from the operational assumptions, which could potentially affect the effectiveness and applicability of the developed control technologies. The system takes a typical ceiling-mounting approach for the photosensor locations, and therefore, the control performance relies on proper commissioning or the built-in intelligence of the photosensor for pertinent task light level estimations. For spaces where daylight penetration diminishes significantly deeper into the zone, certain modification to the control algorithms is required to accommodate multiple lighting control subzones and the corresponding sensors for providing a more uniform light level across the entire zone. Integrated control of visual and thermal comfort requires the lighting control zone and thermal control zone to coincide with each other. In other words, the area illuminated by a lighting circuit needs to be the same area served by the thermostat. Thus, the original zoning will potentially constrain the applicability of this technology in retrofitting projects. This project demonstrated the technical feasibility of a zone-based integrated control technology. From the simulation results and testbed implementations, up to 60% lighting energy savings in daylit areas relative to a “no-controls” case can easily be achieved. A 20% reduction of whole building energy consumption is also attainable. In the aspect of occupant comfort, the testbed demonstrated the ability to maintain specified light level on the workplane while promptly mitigate daylight glare 90% of the time. The control system also managed to maintain the thermal environment at a comfortable level 90% of the time. The aspect of system scalability was guaranteed by the system architecture design, based on which the testbeds were instantiated. Analysis on the aspect of economic benefit has yielded an about 6-year payback time for a medium-sized building, including the installation of all hardware and software, such as motorized blinds and LED luminaires. The payback time can be significantly reduced if part of the hardware is already in place for retrofitting projects. It needs to be noted that since the payback analysis was partly based on the testbed performance results, it is constrained by the caveats associated with the testbed implementations. The main uncertainty lies in the contribution from the space conditioning energy savings as it was non-trivial to realistically configure a room-size HVAC system for directly extrapolating whole-building HVAC energy savings. It is recommended to further evaluate the developed technology at a larger scale, where the lighting and HVAC energy consumption can be realistically measured at the building level, to more rigorously quantify the performance potentials.« less

The Impact of Diabetes on the Labour Force Participation, Savings and Retirement Income of Workers Aged 45-64 Years in Australia

PubMed Central

Schofield, Deborah; Cunich, Michelle; Kelly, Simon; Passey, Megan E.; Shrestha, Rupendra; Callander, Emily; Tanton, Robert; Veerman, Lennert

2015-01-01

Background Diabetes is a debilitating and costly condition. The costs of reduced labour force participation due to diabetes can have severe economic impacts on individuals by reducing their living standards during working and retirement years. Methods A purpose-built microsimulation model of Australians aged 45-64 years in 2010, Health&WealthMOD2030, was used to estimate the lost savings at age 65 due to premature exit from the labour force because of diabetes. Regression models were used to examine the differences between the projected savings and retirement incomes of people at age 65 for those currently working full or part time with no chronic health condition, full or part time with diabetes, and people not in the labour force due to diabetes. Results All Australians aged 45-65 years who are employed full time in 2010 will have accumulated some savings at age 65; whereas only 90.5% of those who are out of the labour force due to diabetes will have done so. By the time they reach age 65, those who retire from the labour force early due to diabetes have a median projected savings of less than $35,000. This is far lower than the median value of total savings for those who remained in the labour force full time with no chronic condition, projected to have $638,000 at age 65. Conclusions Not only does premature retirement due to diabetes limit the immediate income available to individuals with this condition, but it also reduces their long-term financial capacity by reducing their accumulated savings and the income these savings could generate in retirement. Policies designed to support the labour force participation of those with diabetes, or interventions to prevent the onset of the disease itself, should be a priority to preserve living standards comparable with others who do not suffer from this condition. PMID:25706941

A New Method to Directly Observe Tuberculosis Treatment: Skype Observed Therapy, a Patient-Centered Approach.

PubMed

Buchman, Tavora; Cabello, Celina

Tuberculosis (TB) treatment completion is in part determined by patient's adherence to long-term drug regimens. To best ensure compliance, directly observed therapy (DOT) is considered the standard of practice. Nassau County Department of Health TB Control is responsible for providing DOT to patients with TB. Tuberculosis Control sought to use and evaluate Skype Observed Therapy (SOT) as an alternative to DOT for eligible patients. The evaluation included analysis of patient's acceptance and adherence to drug regimen using SOT. Tuberculosis Control assessed staff efficiency and cost savings for this program. Percentages of SOT of patients and successful SOT visits, mileage, and travel time savings. Twenty percent of the caseload used SOT and 100% of patients who were eligible opted in. Average SOT success was 79%. Total mileage savings and time saved were $9,929.07 and 614 hours. Because SOT saves cost and time and is a suitable alternative to DOT for patients, it should be considered as part of new policies and practices in TB control programs.

White Nail Radio Transmitter: Billion Dollar Savings through Energy Efficiency

DTIC Science & Technology

2011-05-10

increase efficiency and reduce overall energy consumption ashore by 50 percent CNO, Navy Energy Vision, P 10 White Nail Vision Your Cell Phone Cell...Estimated Total Number of transmitters 3,000,000 Estimated total power saved Watt 1,250,000,000 Cell Phone Transmitter Efficiency 1.25 Gigawatts saved...Greenhouse Gas Power 4 1 Energy Navy Use 7.3 Billion kWh White Nail Cell Phone Savings 11 Billion kWh One and a half times!!! Saves the output of four of

Evaluating the benefits of digital pathology implementation: Time savings in laboratory logistics.

PubMed

Baidoshvili, Alexi; Bucur, Anca; van Leeuwen, Jasper; van der Laak, Jeroen; Kluin, Philip; van Diest, Paul J

2018-06-20

The benefits of digital pathology for workflow improvement and thereby cost savings in pathology, at least partly outweighing investment costs, are increasingly recognized. Successful implementations in a variety of scenarios start to demonstrate cost benefits of digital pathology for both research and routine diagnostics, contributing to a sound business case encouraging further adoption. To further support new adopters, there is still a need for detailed assessment of the impact this technology has on the relevant pathology workflows with emphasis on time saving. To assess the impact of digital pathology adoption on logistic laboratory tasks (i.e. not including pathologists' time for diagnosis making) in LabPON, a large regional pathology laboratory in The Netherlands. To quantify the benefits of digitization we analyzed the differences between the traditional analog and new digital workflows, carried out detailed measurements of all relevant steps in key analog and digital processes, and compared time spent. We modeled and assessed the logistic savings in five workflows: (1) Routine diagnosis, (2) Multi-disciplinary meeting, (3) External revision requests, (4) Extra stainings and (5) External consultation. On average over 19 working hours were saved on a typical day by working digitally, with the highest savings in routine diagnosis and multi-disciplinary meeting workflows. By working digitally, a significant amount of time could be saved in a large regional pathology lab with a typical case mix. We also present the data in each workflow per task and concrete logistic steps to allow extrapolation to the context and case mix of other laboratories. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

31 CFR 315.93 - Supplements, amendments, or revisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... SAVINGS BONDS, SERIES A, B, C, D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES Miscellaneous Provisions § 315.93 Supplements, amendments, or revisions. The Secretary of the Treasury may at any time, or from time to time, prescribe additional, supplemental, amendatory, or revised rules and regulations...

17 CFR 240.0-2 - Business hours of the Commission.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Eastern Daylight Saving Time, whichever currently is in effect in Washington, DC, provided that hours for... 8 a.m. to 10 p.m., Eastern Standard Time or Eastern Daylight Saving Time, whichever is currently in... Saturdays, Sundays and federal holidays, from 8 a.m. to 5:30 p.m., Eastern Standard Time or Eastern Daylight...

17 CFR 240.0-2 - Business hours of the Commission.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Eastern Daylight Saving Time, whichever currently is in effect in Washington, DC, provided that hours for... 8 a.m. to 10 p.m., Eastern Standard Time or Eastern Daylight Saving Time, whichever is currently in... Saturdays, Sundays and federal holidays, from 8 a.m. to 5:30 p.m., Eastern Standard Time or Eastern Daylight...

The Potential Cost-Effectiveness and Equity Impacts of Restricting Television Advertising of Unhealthy Food and Beverages to Australian Children.

PubMed

Brown, Vicki; Ananthapavan, Jaithri; Veerman, Lennert; Sacks, Gary; Lal, Anita; Peeters, Anna; Backholer, Kathryn; Moodie, Marjory

2018-05-15

Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising until 9:30 pm, and to examine how health benefits and healthcare cost-savings differ by SEP. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by area-level SEP. A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M⁻AUD7M), resulting in modelled reductions in energy intake (mean 115 kJ/day) and body mass index (BMI) (mean 0.352 kg/m²). The intervention is likely to be cost-saving, with 1.4 times higher total cost-savings and 1.5 times higher health benefits in the most disadvantaged socioeconomic group (17,512 HALYs saved (95% UI 10,372⁻25,155); total cost-savings AUD126.3M (95% UI AUD58.7M⁻196.9M) over the lifetime) compared to the least disadvantaged socioeconomic group (11,321 HALYs saved (95% UI 6812⁻15,679); total cost-savings AUD90.9M (95% UI AUD44.3M⁻136.3M)). Legislation to restrict HFSS TV advertising is likely to be cost-effective, with greater health benefits and healthcare cost-savings for children with low SEP.

The Potential Cost-Effectiveness and Equity Impacts of Restricting Television Advertising of Unhealthy Food and Beverages to Australian Children

PubMed Central

Veerman, Lennert; Lal, Anita; Peeters, Anna; Backholer, Kathryn; Moodie, Marjory

2018-01-01

Television (TV) advertising of food and beverages high in fat, sugar and salt (HFSS) influences food preferences and consumption. Children from lower socioeconomic position (SEP) have higher exposure to TV advertising due to more time spent watching TV. This paper sought to estimate the cost-effectiveness of legislation to restrict HFSS TV advertising until 9:30 pm, and to examine how health benefits and healthcare cost-savings differ by SEP. Cost-effectiveness modelling was undertaken (i) at the population level, and (ii) by area-level SEP. A multi-state multiple-cohort lifetable model was used to estimate obesity-related health outcomes and healthcare cost-savings over the lifetime of the 2010 Australian population. Incremental cost-effectiveness ratios (ICERs) were reported, with assumptions tested through sensitivity analyses. An intervention restricting HFSS TV advertising would cost AUD5.9M (95% UI AUD5.8M–AUD7M), resulting in modelled reductions in energy intake (mean 115 kJ/day) and body mass index (BMI) (mean 0.352 kg/m2). The intervention is likely to be cost-saving, with 1.4 times higher total cost-savings and 1.5 times higher health benefits in the most disadvantaged socioeconomic group (17,512 HALYs saved (95% UI 10,372–25,155); total cost-savings AUD126.3M (95% UI AUD58.7M–196.9M) over the lifetime) compared to the least disadvantaged socioeconomic group (11,321 HALYs saved (95% UI 6812–15,679); total cost-savings AUD90.9M (95% UI AUD44.3M–136.3M)). Legislation to restrict HFSS TV advertising is likely to be cost-effective, with greater health benefits and healthcare cost-savings for children with low SEP. PMID:29762517

Estimating the Value of Life, Injury, and Travel Time Saved Using a Stated Preference Framework.

PubMed

Niroomand, Naghmeh; Jenkins, Glenn P

2016-06-01

The incidence of fatality over the period 2010-2014 from automobile accidents in North Cyprus is 2.75 times greater than the average for the EU. With the prospect of North Cyprus entering the EU, many investments will need to be undertaken to improve road safety in order to reach EU benchmarks. The objective of this study is to provide local estimates of the value of a statistical life and injury along with the value of time savings. These are among the parameter values needed for the evaluation of the change in the expected incidence of automotive accidents and time savings brought about by such projects. In this study we conducted a stated choice experiment to identify the preferences and tradeoffs of automobile drivers in North Cyprus for improved travel times, travel costs, and safety. The choice of route was examined using mixed logit models to obtain the marginal utilities associated with each attribute of the routes that consumers choose. These estimates were used to assess the individuals' willingness to pay (WTP) to avoid fatalities and injuries and to save travel time. We then used the results to obtain community-wide estimates of the value of a statistical life (VSL) saved, the value of injury (VI) prevented, and the value per hour of travel time saved. The estimates for the VSL range from €315,293 to €1,117,856 and the estimates of VI from € 5,603 to € 28,186. These values are consistent, after adjusting for differences in incomes, with the median results of similar studies done for EU countries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Incorporating indirect costs into a cost-benefit analysis of laparoscopic adjustable gastric banding.

PubMed

Finkelstein, Eric A; Allaire, Benjamin T; Dibonaventura, Marco Dacosta; Burgess, Somali M

2012-01-01

The objective of this study was to estimate the time to breakeven and 5-year net costs of laparoscopic adjustable gastric banding (LAGB) taking both direct and indirect costs and cost savings into account. Estimates of direct cost savings from LAGB were available from the literature. Although longitudinal data on indirect cost savings were not available, these estimates were generated by quantifying the relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and combining these elasticity estimates with estimates of the direct cost savings to generate total savings. These savings were then combined with the direct and indirect costs of the procedure to quantify net savings. By including indirect costs, the time to breakeven was reduced by half a year, from 16 to 14 quarters. After 5 years, net savings in medical expenditures from a gastric banding procedure were estimated to be $4970 (±$3090). Including absenteeism increased savings to $6180 (±$3550). Savings were further increased to $10,960 (±$5864) when both absenteeism and presenteeism estimates were included. This study presented a novel approach for including absenteeism and presenteeism estimates in cost-benefit analyses. Application of the approach to gastric banding among surgery-eligible obese employees revealed that the inclusion of indirect costs and cost savings improves the business case for the procedure. This approach can easily be extended to other populations and treatments. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Hospital cost structure in the USA: what's behind the costs? A business case.

PubMed

Chandra, Charu; Kumar, Sameer; Ghildayal, Neha S

2011-01-01

Hospital costs in the USA are a large part of the national GDP. Medical billing and supplies processes are significant and growing contributors to hospital operations costs in the USA. This article aims to identify cost drivers associated with these processes and to suggest improvements to reduce hospital costs. A Monte Carlo simulation model that uses @Risk software facilitates cost analysis and captures variability associated with the medical billing process (administrative) and medical supplies process (variable). The model produces estimated savings for implementing new processes. Significant waste exists across the entire medical supply process that needs to be eliminated. Annual savings, by implementing the improved process, have the potential to save several billion dollars annually in US hospitals. The other analysis in this study is related to hospital billing processes. Increased spending on hospital billing processes is not entirely due to hospital inefficiency. The study lacks concrete data for accurately measuring cost savings, but there is obviously room for improvement in the two US healthcare processes. This article only looks at two specific costs associated with medical supply and medical billing processes, respectively. This study facilitates awareness of escalating US hospital expenditures. Cost categories, namely, fixed, variable and administrative, are presented to identify the greatest areas for improvement. The study will be valuable to US Congress policy makers and US healthcare industry decision makers. Medical billing process, part of a hospital's administrative costs, and hospital supplies management processes are part of variable costs. These are the two major cost drivers of US hospitals' expenditures that were examined and analyzed.

A Study on the Optimal Duration of Daylight Saving Time (DST) in Korea

NASA Astrophysics Data System (ADS)

Mihn, Byeong-Hee; Ahn, Young Sook; Kim, Dong-Bin; Yang, Hong-Jin

2009-09-01

Daylight saving time aims at spending effective daylight in summer season. Korea had enforced daylight saving time twelve times from 1948 to 1988. Since 1988, it is not executed, but it is recently discussed the resumption of DST. In this paper, we investigate the trend of DST in other countries, review the history of DST in Korea, and suggest the optimal DST duration in terms of astronomical aspects (times of sunrise and sunset). We find that the starting day of DST in Korea is apt for the second Sunday in May or the second Sunday in April according to the time of sunrise or to the difference between Korean standard meridian and observer's, respectively. We also discuss time friction that might be caused by time difference between DST and Korea Standard Time (KST).

TeamSTEPPS Improves Operating Room Efficiency and Patient Safety.

PubMed

Weld, Lancaster R; Stringer, Matthew T; Ebertowski, James S; Baumgartner, Timothy S; Kasprenski, Matthew C; Kelley, Jeremy C; Cho, Doug S; Tieva, Erwin A; Novak, Thomas E

2016-09-01

The objective was to evaluate the effect of TeamSTEPPS on operating room efficiency and patient safety. TeamSTEPPS consisted of briefings attended by all health care personnel assigned to the specific operating room to discuss issues unique to each case scheduled for that day. The operative times, on-time start rates, and turnover times of all cases performed by the urology service during the initial year with TeamSTEPPS were compared to the prior year. Patient safety issues identified during postoperative briefings were analyzed. The mean case time was 12.7 minutes less with TeamSTEPPS (P < .001). The on-time first-start rate improved by 21% with TeamSTEPPS (P < .001). The mean room turnover time did not change. Patient safety issues declined from an initial rate of 16% to 6% at midyear and remained stable (P < 0.001). TeamSTEPPS was associated with improved operating room efficiency and diminished patient safety issues in the operating room. © The Author(s) 2015.

Surgical emergencies in obstetrics and gynaecology in a tertiary care hospital.

PubMed

Pokharel, Hanoon P; Dahal, Prerana; Rai, Rubina; Budhathoki, ShyamSundar

2013-01-01

The management of Obstetrics and Gynaecological Emergency is directed at the preservation of life, health, sexual function and the perpetuation of fertility. Main aim of the study was to access the burden of Surgical Emergency in Obstetrics and Gynaecology and their course of management at BPKIHS. A total of 314 women presenting at the emergency admission room of Obstetrics and Gynaecology Department of BPKIHS over two years, who required surgical intervention were included in this hospital based descriptive study. Clinical assessment and routine laboratory investigations were performed in all cases. All patients who presented with shock were resuscitated and surgery was done at earliest possible time. The age of patients ranged from 15- 55 years with approximately 43% in the 25-34 years category. Ninety two percent of them were married. Among the unmarried, 64% came with problems related to unsafe abortion. About 61% of females presenting as acute surgical abdomen had ruptured ectopic pregnancy, 7.64% had twisted ovarian cyst, and 6.26% had haemoperitoneum and pyoperitoneum following vaginal hysterectomies, total abdominal hysterectomies and caesarean section. Almost half (47.8%) of the cases underwent salphingectomy. Women present with wide range of complaints and conditions in the admission room of Obstetrics and Gynecology department of BPKIHS. Skilled clinicians, immediate investigation facilities and experienced specialty Obstetrical and Gynaecological surgeons are the main backbone of the emergency case management and saving lives. Study indicates there is need of some prospective study to establish the causes of rising trend in Ectopic Pregnancies.

Correlation of classroom typologies to lighting energy performance of academic building in warm-humid climate (case study: ITS Campus Sukolilo Surabaya)

NASA Astrophysics Data System (ADS)

Ekasiwi, S. N. N.; Antaryama, I. G. N.; Krisdianto, J.; Ulum, M. S.

2018-03-01

Classrooms in educational buildings require certain lighting requirements to serve teaching and learning activities during daytime. The most typical design is double sided opening in order to get good daylight distribution in the classroom. Using artificial light is essential to contribute the worse daylight condition. A short observation indicates that during the lecture time the light turned on, even in the daytime. That might result in wasting electrical energy. The aim of the study is to examine the type of classroom, which perform comfortable lighting environment as well as saving energy. This paper reports preliminary results of the study obtained from field observation and measurements. The use of energy and usage pattern of artificial lighting during the lecture is recorded and then the data evaluated to see the suitability of existing energy use to building energy standards. The daylighting design aspects have to be the first consideration. However, the similarity in WWR of the classroom, the Daylight Factor (DF) may differ. It depends on the room depth. The similarity of the increase of WWR and Ratio of openings to floor area do not directly correspond to the increase of DF. The outdoor condition of larger daylight access and the room depth are the influencing factors. Despite the similarity of physical type, usage pattern of the classroom imply the use of electrical energy for lighting. The results indicate the factors influencing lighting energy performance in correlation to their typologies

Initial experience with a nuclear medicine viewing workstation

NASA Astrophysics Data System (ADS)

Witt, Robert M.; Burt, Robert W.

1992-07-01

Graphical User Interfaced (GUI) workstations are now available from commercial vendors. We recently installed a GUI workstation in our nuclear medicine reading room for exclusive use of staff and resident physicians. The system is built upon a Macintosh platform and has been available as a DELTAmanager from MedImage and more recently as an ICON V from Siemens Medical Systems. The workstation provides only display functions and connects to our existing nuclear medicine imaging system via ethernet. The system has some processing capabilities to create oblique, sagittal and coronal views from transverse tomographic views. Hard copy output is via a screen save device and a thermal color printer. The DELTAmanager replaced a MicroDELTA workstation which had both process and view functions. The mouse activated GUI has made remarkable changes to physicians'' use of the nuclear medicine viewing system. Training time to view and review studies has been reduced from hours to about 30-minutes. Generation of oblique views and display of brain and heart tomographic studies has been reduced from about 30-minutes of technician''s time to about 5-minutes of physician''s time. Overall operator functionality has been increased so that resident physicians with little prior computer experience can access all images on the image server and display pertinent patient images when consulting with other staff.

Defense.gov Special Report: The Virtual Worlds of DOD

Science.gov Websites

for training, research and a growing number of other activities to save money, time and lives. May 9 Defense Department will save money, time, and ultimately, lives, he said, and it's his job to make that

Multi-sensor Array for High Altitude Balloon Missions to the Stratosphere

NASA Astrophysics Data System (ADS)

Davis, Tim; McClurg, Bryce; Sohl, John

2008-10-01

We have designed and built a microprocessor controlled and expandable multi-sensor array for data collection on near space missions. Weber State University has started a high altitude research balloon program called HARBOR. This array has been designed to data log a base set of measurements for every flight and has room for six guest instruments. The base measurements are absolute pressure, on-board temperature, 3-axis accelerometer for attitude measurement, and 2-axis compensated magnetic compass. The system also contains a real time clock and circuitry for logging data directly to a USB memory stick. In typical operation the measurements will be cycled through in sequence and saved to the memory stick along with the clock's time stamp. The microprocessor can be reprogrammed to adapt to guest experiments with either analog or digital interfacing. This system will fly with every mission and will provide backup data collection for other instrumentation for which the primary task is measuring atmospheric pressure and temperature. The attitude data will be used to determine the orientation of the onboard camera systems to aid in identifying features in the images. This will make these images easier to use for any future GIS (geographic information system) remote sensing missions.

Bluetooth wireless database for scoliosis clinics.

PubMed

Lou, E; Fedorak, M V; Hill, D L; Raso, J V; Moreau, M J; Mahood, J K

2003-05-01

A database system with Bluetooth wireless connectivity has been developed so that scoliosis clinics can be run more efficiently and data can be mined for research studies without significant increases in equipment cost. The wireless database system consists of a Bluetooth-enabled laptop or PC and a Bluetooth-enabled handheld personal data assistant (PDA). Each patient has a profile in the database, which has all of his or her clinical history. Immediately prior to the examination, the orthopaedic surgeon selects a patient's profile from the database and uploads that data to the PDA over a Bluetooth wireless connection. The surgeon can view the entire clinical history of the patient while in the examination room and, at the same time, enter in any new measurements and comments from the current examination. After seeing the patient, the surgeon synchronises the newly entered information with the database wirelessly and prints a record for the chart. This combination of the database and the PDA both improves efficiency and accuracy and can save significant time, as there is less duplication of work, and no dictation is required. The equipment required to implement this solution is a Bluetooth-enabled PDA and a Bluetooth wireless transceiver for the PC or laptop.

A study of 6S workplace improvement in Ergonomic Laboratory

NASA Astrophysics Data System (ADS)

Sari, AD; Suryoputro, MR; Rahmillah, FI

2017-12-01

This article discusses 6S implementation in Ergonomic Laboratory, Department of Industrial Engineering, Islamic University of Indonesia. This research is improvement project of 5S implementation in Ergonomic laboratory. Referring to the 5S implementation of the previous year, there have been improvements from environmental conditions or a more organized workplace however there is still a lack of safety aspects. There are several safeties problems such as equipment arrangement, potential hazards of room dividers that cause injury several times, placement of fire extinguisher, no evacuation path and assembly point in case of fire, as well as expired hydrant condition and lack of awareness of stakeholders related to safety. Therefore, this study aims to apply the 6S kaizen method to the Ergonomic laboratory to facilitate the work process, reduce waste, improve work safety and improve staff performance. Based on the score 6S assessment increased audit results by 32 points, before implementation is 75 point while after implementation is 107 point. This has implications for better use for mitigate people in laboratory area, save time when looking for tools and materials, safe workplace, as well as improving the culture and spirit of ‘6S’ on staff due to better and safetier working environment.

Clinical impact and value of workstation single sign-on.

PubMed

Gellert, George A; Crouch, John F; Gibson, Lynn A; Conklin, George S; Webster, S Luke; Gillean, John A

2017-05-01

CHRISTUS Health began implementation of computer workstation single sign-on (SSO) in 2015. SSO technology utilizes a badge reader placed at each workstation where clinicians swipe or "tap" their identification badges. To assess the impact of SSO implementation in reducing clinician time logging in to various clinical software programs, and in financial savings from migrating to a thin client that enabled replacement of traditional hard drive computer workstations. Following implementation of SSO, a total of 65,202 logins were sampled systematically during a 7day period among 2256 active clinical end users for time saved in 6 facilities when compared to pre-implementation. Dollar values were assigned to the time saved by 3 groups of clinical end users: physicians, nurses and ancillary service providers. The reduction of total clinician login time over the 7day period showed a net gain of 168.3h per week of clinician time - 28.1h (2.3 shifts) per facility per week. Annualized, 1461.2h of mixed physician and nursing time is liberated per facility per annum (121.8 shifts of 12h per year). The annual dollar cost savings of this reduction of time expended logging in is $92,146 per hospital per annum and $1,658,745 per annum in the first phase implementation of 18 hospitals. Computer hardware equipment savings due to desktop virtualization increases annual savings to $2,333,745. Qualitative value contributions to clinician satisfaction, reduction in staff turnover, facilitation of adoption of EHR applications, and other benefits of SSO are discussed. SSO had a positive impact on clinician efficiency and productivity in the 6 hospitals evaluated, and is an effective and cost-effective method to liberate clinician time from repetitive and time consuming logins to clinical software applications. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

GMP-conformant on-site manufacturing of a CD133+ stem cell product for cardiovascular regeneration.

PubMed

Skorska, Anna; Müller, Paula; Gaebel, Ralf; Große, Jana; Lemcke, Heiko; Lux, Cornelia A; Bastian, Manuela; Hausburg, Frauke; Zarniko, Nicole; Bubritzki, Sandra; Ruch, Ulrike; Tiedemann, Gudrun; David, Robert; Steinhoff, Gustav

2017-02-10

CD133 + stem cells represent a promising subpopulation for innovative cell-based therapies in cardiovascular regeneration. Several clinical trials have shown remarkable beneficial effects following their intramyocardial transplantation. Yet, the purification of CD133 + stem cells is typically performed in centralized clean room facilities using semi-automatic manufacturing processes based on magnetic cell sorting (MACS®). However, this requires time-consuming and cost-intensive logistics. CD133 + stem cells were purified from patient-derived sternal bone marrow using the recently developed automatic CliniMACS Prodigy® BM-133 System (Prodigy). The entire manufacturing process, as well as the subsequent quality control of the final cell product (CP), were realized on-site and in compliance with EU guidelines for Good Manufacturing Practice. The biological activity of automatically isolated CD133 + cells was evaluated and compared to manually isolated CD133 + cells via functional assays as well as immunofluorescence microscopy. In addition, the regenerative potential of purified stem cells was assessed 3 weeks after transplantation in immunodeficient mice which had been subjected to experimental myocardial infarction. We established for the first time an on-site manufacturing procedure for stem CPs intended for the treatment of ischemic heart diseases using an automatized system. On average, 0.88 × 10 6 viable CD133 + cells with a mean log 10 depletion of 3.23 ± 0.19 of non-target cells were isolated. Furthermore, we demonstrated that these automatically isolated cells bear proliferation and differentiation capacities comparable to manually isolated cells in vitro. Moreover, the automatically generated CP shows equal cardiac regeneration potential in vivo. Our results indicate that the Prodigy is a powerful system for automatic manufacturing of a CD133 + CP within few hours. Compared to conventional manufacturing processes, future clinical application of this system offers multiple benefits including stable CP quality and on-site purification under reduced clean room requirements. This will allow saving of time, reduced logistics and diminished costs.

Impact of Hospital-Employed Physician Assistants on a Level II Community-Based Orthopaedic Trauma System.

PubMed

Althausen, Peter L; Shannon, Steven; Owens, Brianne; Coll, Daniel; Cvitash, Michael; Lu, Minggen; O'Mara, Timothy J; Bray, Timothy J

2016-12-01

The American Academy of Orthopedic Surgeons and the Orthopedic Trauma Association have released guidelines for the provision of orthopedic trauma services such as adequate stipends, designated operating rooms, ancillary staff, and guaranteed reimbursement for indigent care. One recommendation included a provision for hospital-based physician assistants (PAs). Given current reimbursement arrangements, PA collections for billable services may not meet their salary and benefit expenses. However, their actions may indirectly affect emergency room, operating room, and hospital reimbursement and patient care itself. The purpose of our study is to define the true impact of hospitalbased PAs on orthopaedic trauma care at a level II community hospital. Retrospective case series. Level II trauma center. One thousand one hundred four trauma patients with orthopaedic injuries. PA involvement. Emergency room data such as triage time, time until seen by the orthopedic service, and total emergency room time was recorded. Operating room data such as time to surgery, set-up time, total operating time, and out of room time was entered as well. Charts were reviewed to determine if patients were given postoperative antibiotics and Deep Venous Thrombosis (DVT) prophylaxis. Intraoperative and postoperative complications were noted, and lengths of stay were calculated for all patients. At our institution, PA collections from patient care cover only 50% of their costs for salary and benefits. However, with PA involvement, trauma patients with orthopedic injuries were seen 205 minutes faster (P = 0.006), total Emergency Room (ER) time decreased 175 minutes (P = 0.0001), and time to surgery improved 360 minutes (P . 0.03). Operating room parameters were minimally improved, but postoperative DVT prophylaxis increased by a mean of 6.73% (P = 0.0084), postoperative antibiotic administration increased by 2.88% (P = 0.0302), and there was a 4.67% decrease in postoperative complications (P = 0.0034). Average length of stay decreased by 0.61 days (P = 0.27). Although the PA's collections do not cover their costs, the indirect economic and patient care impacts are clear. By increasing emergency room pull through and decreasing times to Operating Room (OR), operative times, lengths of stay, and complications, their existence is clearly beneficial to hospitals, physicians, and patients as well. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Atlanta congestion reduction demonstration. National evaluation : cost benefit analysis test plan.

DOT National Transportation Integrated Search

2001-01-01

Initiatives to evaluate the impact of Advanced Traveler Information Services (ATIS) over the last ten years have returned what appears to be contradictory results with respect to the time savings of ATIS users: large perceived time savings reported b...

Help!

ERIC Educational Resources Information Center

Adams, Caralee

2006-01-01

This article presents ten time-saving ideas for teachers. One great time-saving tip is to come in an hour early once or twice a week for grading papers. It is also a great idea if teachers will not give tests on Friday in order to reduce their weekend work.

Early detection and control of an Acinetobacter baumannii multi-resistant outbreak in a hospital in Quito, Ecuador.

PubMed

Cartelle Gestal, Monica; Zurita, Jeannete; Gualpa, Gabriela; Gonzalez, Cecibel; Paz Y Mino, Ariane

2016-12-30

Acinetobacter baumannii (ABA) is an important opportunistic pathogen associated with high mortality rates in intensive care units (ICUs). An outbreak in the ICU of a secondary-level hospital in Quito, Ecuador, occurred during April and May 2015 and was successfully controlled. Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) and repetitive element palindromic (REP)-PCR was conducted on all isolates recovered from patients, as well as environmental samples, to confirm the presence of an outbreak. A case-control study was conducted by comparing the clinical histories of the affected patients and of control patients present in the ICU during the outbreak period who did not present a positive culture for ABA. Five patients were infected and two were colonized with the same clonal strain of ABA, which was also identified on the stethoscope and a monitor associated with an isolation room. Statistical analysis of case histories did not identify any additional risk factors, but the outbreak was initiated by one patient in the isolation room of the ICU who was infected with the outbreak strain. All patients who ocupied that room after the index case tested positive for at least one culture of ABA. The outbreak strain was found on the stethoscope, and a subclone was found on the monitor of that room. Having access to basic equipment will enable well-trained professionals to rapidly detect and initiate the control process of an outbreak, saving lives and money spent on nosocomial infection treatments.

Architectural acoustics in residences for adults with mental retardation and its relation to perceived homelikeness.

PubMed

Egli, M; Roper, T; Feurer, I; Thompson, T

1999-01-01

Previous investigators examined how architectural features of residences for adults with mental retardation contributed to the visual appearance of homelikeness. Acoustical characteristics of 18 residences for people with mental retardation were examined here. As part of a concurrent study, college undergraduates rated photographs of rooms in each house for their apparent homelikeness. Reverberation times in living and dining rooms were negatively correlated with mean homelikeness ratings. The less homelike rooms had reverberation times that may interfere with speech perception for some people and that were comparable with those found in larger public rooms (e.g., lecture halls). The larger reverberation times in these rooms were the result of insufficient sound absorption by these rooms' furnishings.

Colorado's Alternative School Calendar Program.

ERIC Educational Resources Information Center

Stiverson, C. L.

1982-01-01

Colorado's 22 school districts on a four-day week schedule, as authorized by Colorado Senate Bill 78, show comparable student achievement levels as those on a five-day schedule; support from parents, teachers; and students; improved energy savings and/or time savings; and cost savings. Five other possible benefits are listed. (LC)

31 CFR 315.10 - Limitations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... applicable to each series of bonds and savings notes for each specific year, which has varied from time to..., DEPARTMENT OF THE TREASURY BUREAU OF THE FISCAL SERVICE REGULATIONS GOVERNING U.S. SAVINGS BONDS, SERIES A, B... Limitations. Specific limitations have been placed on the amounts of bonds of each series and savings notes...

An assessment of the quality indicators of operative and non-operative times in a public university hospital.

PubMed

Costa, Altair da Silva; Leão, Luiz Eduardo Villaça; Novais, Maykon Anderson Pires de; Zucchi, Paola

2015-01-01

To assess the operative time indicators in a public university hospital. A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6 ± 110 and 129.8 ± 97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8 ± 113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3 ± 17.3 minutes. The time to set the next patient in operating room was 119.8 ± 79.6 minutes. Our total non-operative time was 155 minutes. Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

Fluorescent carbon dots: facile synthesis at room temperature and its application for Fe2+ sensing

NASA Astrophysics Data System (ADS)

Xiao, Sai Jin; Chu, Zhao Jun; Zuo, Jun; Zhao, Xiao Jing; Huang, Cheng Zhi; Zhang, Li

2017-02-01

A new route for one-pot preparation of carbon dots (CDs) was developed at room temperature using PEG400 as both the carbon source and passitive agent. The new method possesses the advantages of facile, rapid, energy-saving, without any external stimulus and environment friendly. By changing the content of NaOH, the PEG400-CDs with blue-emitting, yellow-emitting, orange red-emitting and red-emitting were obtained, and the formation mechanism were carefully investigated. In addition, a sensitive fluorescence sensor were developed for Fe2+ detection based on PEG400-CDs since the fluorescence of PEG400-CDs could be enhanced by Fe2+. It was found that there is a good linear relationship between the enhanced fluorescence and Fe2+ concentration in the range of 0.5 to 2.0 μmol·L-1 with the detection limit of 6.0 × 10-8 mol·L-1, and Fe2+ in water samples was also determined with high accuracy and repeatability.

Nurse practitioner coverage is associated with a decrease in length of stay in a pediatric chronic ventilator dependent unit

PubMed Central

Rowan, Courtney M; Cristea, A Ioana; Hamilton, Jennifer C; Taylor, Nicole M; Nitu, Mara E; Ackerman, Veda L

2016-01-01

AIM: To hypothesize a dedicated critical care nurse practitioner (NP) is associated with a decreased length of stay (LOS) from a pediatric chronic ventilator dependent unit (PCVDU). METHODS: We retrospectively reviewed patients requiring care in the PCVDU from May 2001 through May 2011 comparing the 5 years prior to the 5 years post implementation of the critical care NP in 2005. LOS and room charges were obtained. RESULTS: The average LOS decreased from a median of 55 d [interquartile range (IQR): 9.8-108.3] to a median of 12 (IQR: 4.0-41.0) with the implementation of a dedicated critical care NP (P < 1.0001). Post implementation of a dedicated NP, a savings of 25738049 in room charges was noted over 5 years. CONCLUSION: Our data demonstrates a critical care NP coverage model in a PCVDU is associated with a significantly reduced LOS demonstrating that the NP is an efficient and likely cost-effective addition to a medically comprehensive service. PMID:27170929

Performance of raw bovine meat preservation by hyperbaric storage (quasi energetically costless) compared to refrigeration.

PubMed

Freitas, Paulo; Pereira, Sofia A; Santos, Mauro D; Alves, Susana P; Bessa, Rui J B; Delgadillo, Ivonne; Saraiva, Jorge A

2016-11-01

Hyperbaric storage at room temperature (without temperature control) of raw bovine meat was studied and compared to refrigeration. Samples were first stored for 12h at 50, 100 and 150MPa, and in a second set of experiments, for a longer period of 10days at 50MPa. For the 12h storage, refrigeration and 50MPa had a similar microbial growth inhibition effect and, at 100 and 150MPa an additional microbial inactivation effect was found. For the longer experiment (10days at 50MPa) results pointed for a shelf-life increase of raw beef compared to samples stored under refrigeration. For both tests (12h and 10days) samples preserved under pressure showed no detrimental effect on physicochemical parameters comparatively to the initial and refrigerated samples. These results indicate that hyperbaric storage at room temperature not only allows high energy savings, but additionally has potential to extend the shelf-life of a perishable food product compared to refrigeration. Copyright © 2016 Elsevier Ltd. All rights reserved.

A low-temperature ZnO nanowire ethanol gas sensor prepared on plastic substrate

NASA Astrophysics Data System (ADS)

Lin, Chih-Hung; Chang, Shoou-Jinn; Hsueh, Ting-Jen

2016-09-01

In this work, a low-temperature ZnO nanowire ethanol gas sensor was prepared on plastic substrate. The operating temperature of the ZnO nanowire ethanol gas sensor was reduced to room temperature using ultraviolet illumination. The experimental results indicate a favorable sensor response at low temperature, with the best response at 60 °C. The results also reveal that the ZnO nanowire ethanol gas sensor can be easily integrated into portable products, whose waste heat can improve sensor response and achieve energy savings, while energy consumption can be further reduced by solar irradiation.

Holographic daylighting

NASA Astrophysics Data System (ADS)

Ludman, Jacques E.; Riccobono, Juanita R.; Savant, Gajendra D.; Jannson, Joanna L.; Campbell, Eugene W.; Hall, Robyn

1995-09-01

Daylighting techniques are an effective means of reducing both lighting and cooling costs; however, many of the standard techniques have flaws which reduce their effectiveness. Daylighting holograms are an efficient and effective method for diffracting sunlight up onto the ceiling, deep in a room, without diffracting the light at eye-level. They need only cover the top half of a window to produce significant energy savings. They may be used as part of a new glazing system or as a retrofit to existing windows. These holograms are broadband and are able to passively track the movement of the sun across the sky, throughout the day and year.

Facilitating the 3D Indoor Search and Rescue Problem: An Overview of the Problem and an Ant Colony Solution Approach

NASA Astrophysics Data System (ADS)

Tashakkori, H.; Rajabifard, A.; Kalantari, M.

2016-10-01

Search and rescue procedures for indoor environments are quite complicated due to the fact that much of the indoor information is unavailable to rescuers before physical entrance to the incident scene. Thus, decision making regarding the number of crew required and the way they should be dispatched in the building considering the various access points and complexities in the buildings in order to cover the search area in minimum time is dependent on prior knowledge and experience of the emergency commanders. Hence, this paper introduces the Search and Rescue Problem (SRP) which aims at finding best search and rescue routes that minimize the overall search time in the buildings. 3D BIM-oriented indoor GIS is integrated in the indoor route graph to find accurate routes based on the building geometric and semantic information. An Ant Colony Based Algorithm is presented that finds the number of first responders required and their individual routes to search all rooms and points of interest inside the building to minimize the overall time spent by all rescuers inside the disaster area. The evaluation of the proposed model for a case study building shows a significant improve in search and rescue time which will lead to a higher chance of saving lives and less exposure of emergency crew to danger.

Dynamic Weather Routes: A Weather Avoidance Concept for Trajectory-Based Operations

NASA Technical Reports Server (NTRS)

McNally, B. David; Love, John

2011-01-01

The integration of convective weather modeling with trajectory automation for conflict detection, trial planning, direct routing, and auto resolution has uncovered a concept that could help controllers, dispatchers, and pilots identify improved weather routes that result in significant savings in flying time and fuel burn. Trajectory automation continuously and automatically monitors aircraft in flight to find those that could potentially benefit from improved weather reroutes. Controllers, dispatchers, and pilots then evaluate reroute options to assess their suitability given current weather and traffic. In today's operations aircraft fly convective weather avoidance routes that were implemented often hours before aircraft approach the weather and automation does not exist to automatically monitor traffic to find improved weather routes that open up due to changing weather conditions. The automation concept runs in real-time and employs two keysteps. First, a direct routing algorithm automatically identifies flights with large dog legs in their routes and therefore potentially large savings in flying time. These are common - and usually necessary - during convective weather operations and analysis of Fort Worth Center traffic shows many aircraft with short cuts that indicate savings on the order of 10 flying minutes. The second and most critical step is to apply trajectory automation with weather modeling to determine what savings could be achieved by modifying the direct route such that it avoids weather and traffic and is acceptable to controllers and flight crews. Initial analysis of Fort Worth Center traffic suggests a savings of roughly 50% of the direct route savings could be achievable.The core concept is to apply trajectory automation with convective weather modeling in real time to identify a reroute that is free of weather and traffic conflicts and indicates enough time and fuel savings to be considered. The concept is interoperable with today's integrated FMS/datalink. Auxiliary(lat/long) waypoints define a minimum delay reroute between current position and a downstream capture fix beyond the weather. These auxiliary waypoints can be uplinked to equipped aircraft and auto-loaded into the FMS. Alternatively, for unequipped aircraft, auxiliary waypoints can be replaced by nearby named fixes, but this could reduce potential savings. The presentation includes an overview of the automation approach and focuses on several cases in terms of potential savings, reroute complexity, best auxiliary waypoint solution vs. named fix solution, and other metrics.

The Significance of Temperature Based Approach Over the Energy Based Approaches in the Buildings Thermal Assessment

NASA Astrophysics Data System (ADS)

Albatayneh, Aiman; Alterman, Dariusz; Page, Adrian; Moghtaderi, Behdad

2017-05-01

The design of low energy buildings requires accurate thermal simulation software to assess the heating and cooling loads. Such designs should sustain thermal comfort for occupants and promote less energy usage over the life time of any building. One of the house energy rating used in Australia is AccuRate, star rating tool to assess and compare the thermal performance of various buildings where the heating and cooling loads are calculated based on fixed operational temperatures between 20 °C to 25 °C to sustain thermal comfort for the occupants. However, these fixed settings for the time and temperatures considerably increase the heating and cooling loads. On the other hand the adaptive thermal model applies a broader range of weather conditions, interacts with the occupants and promotes low energy solutions to maintain thermal comfort. This can be achieved by natural ventilation (opening window/doors), suitable clothes, shading and low energy heating/cooling solutions for the occupied spaces (rooms). These activities will save significant amount of operating energy what can to be taken into account to predict energy consumption for a building. Most of the buildings thermal assessment tools depend on energy-based approaches to predict the thermal performance of any building e.g. AccuRate in Australia. This approach encourages the use of energy to maintain thermal comfort. This paper describes the advantages of a temperature-based approach to assess the building's thermal performance (using an adaptive thermal comfort model) over energy based approach (AccuRate Software used in Australia). The temperature-based approach was validated and compared with the energy-based approach using four full scale housing test modules located in Newcastle, Australia (Cavity Brick (CB), Insulated Cavity Brick (InsCB), Insulated Brick Veneer (InsBV) and Insulated Reverse Brick Veneer (InsRBV)) subjected to a range of seasonal conditions in a moderate climate. The time required for heating and/or cooling using the adaptive thermal comfort approach and AccuRate predictions were estimated. Significant savings (of about 50 %) in energy consumption in minimising the time required for heating and cooling were achieved by using the adaptive thermal comfort model.

Nonconvex model predictive control for commercial refrigeration

NASA Astrophysics Data System (ADS)

Gybel Hovgaard, Tobias; Boyd, Stephen; Larsen, Lars F. S.; Bagterp Jørgensen, John

2013-08-01

We consider the control of a commercial multi-zone refrigeration system, consisting of several cooling units that share a common compressor, and is used to cool multiple areas or rooms. In each time period we choose cooling capacity to each unit and a common evaporation temperature. The goal is to minimise the total energy cost, using real-time electricity prices, while obeying temperature constraints on the zones. We propose a variation on model predictive control to achieve this goal. When the right variables are used, the dynamics of the system are linear, and the constraints are convex. The cost function, however, is nonconvex due to the temperature dependence of thermodynamic efficiency. To handle this nonconvexity we propose a sequential convex optimisation method, which typically converges in fewer than 5 or so iterations. We employ a fast convex quadratic programming solver to carry out the iterations, which is more than fast enough to run in real time. We demonstrate our method on a realistic model, with a full year simulation and 15-minute time periods, using historical electricity prices and weather data, as well as random variations in thermal load. These simulations show substantial cost savings, on the order of 30%, compared to a standard thermostat-based control system. Perhaps more important, we see that the method exhibits sophisticated response to real-time variations in electricity prices. This demand response is critical to help balance real-time uncertainties in generation capacity associated with large penetration of intermittent renewable energy sources in a future smart grid.

The SmartOR: a distributed sensor network to improve operating room efficiency.

PubMed

Huang, Albert Y; Joerger, Guillaume; Fikfak, Vid; Salmon, Remi; Dunkin, Brian J; Bass, Barbara L; Garbey, Marc

2017-09-01

Despite the significant expense of OR time, best practice achieves only 70% efficiency. Compounding this problem is a lack of real-time data. Most current OR utilization programs require manual data entry. Automated systems require installation and maintenance of expensive tracking hardware throughout the institution. This study developed an inexpensive, automated OR utilization system and analyzed data from multiple operating rooms. OR activity was deconstructed into four room states. A sensor network was then developed to automatically capture these states using only three sensors, a local wireless network, and a data capture computer. Two systems were then installed into two ORs, recordings captured 24/7. The SmartOR recorded the following events: any room activity, patient entry/exit time, anesthesia time, laparoscopy time, room turnover time, and time of preoperative patient identification by the surgeon. From November 2014 to December 2015, data on 1003 cases were collected. The mean turnover time was 36 min, and 38% of cases met the institutional goal of ≤30 min. Data analysis also identified outlier cases (>1 SD from mean) in the domains of time from patient entry into the OR to intubation (11% of cases) and time from extubation to patient exiting the OR (11% of cases). Time from surgeon identification of patient to scheduled procedure start time was 11 min (institution bylaws require 20 min before scheduled start time), yet OR teams required 22 min on average to bring a patient into the room after surgeon identification. The SmartOR automatically and reliably captures data on OR room state and, in real time, identifies outlier cases that may be examined closer to improve efficiency. As no manual entry is required, the data are indisputable and allow OR teams to maintain a patient-centric focus.

Investigation of Preparation and Mechanisms of a Dispersed Particle Gel Formed from a Polymer Gel at Room Temperature

PubMed Central

Zhao, Guang; Dai, Caili; Zhao, Mingwei; You, Qing; Chen, Ang

2013-01-01

A dispersed particle gel (DPG) was successfully prepared from a polymer gel at room temperature. The polymer gel system, morphology, viscosity changes, size distribution, and zeta potential of DPG particles were investigated. The results showed that zirconium gel systems with different strengths can be cross-linked within 2.5 h at low temperature. Scanning electron microscopy (SEM), transmission electron microscopy (TEM), and atomic force microscopy (AFM) results showed that the particles were polygonal particles with nano-size distribution. According to the viscosity changes, the whole preparation process can be divided into two major stages: the bulk gel cross-linking reaction period and the DPG particle preparation period. A polymer gel with a 3-dimensional network was formed in the bulk gel cross-linking reaction period whereas shearing force and frictional force were the main driving forces for the preparation of DPG particles, and thus affected the morphology of DPG particles. High shearing force and frictional force reduced the particle size distribution, and then decreased the zeta potential (absolute value). The whole preparation process could be completed within 3 h at room temperature. It could be an efficient and energy-saving technology for preparation of DPG particles. PMID:24324817

The Influence of a Postdischarge Intervention on Reducing Hospital Readmissions in a Medicare Population

PubMed Central

Frey, Beth; Hall, Benjamin; Painter, Philip

2013-01-01

Abstract Hospital readmissions in the Medicare population may be related to a number of factors, including reoccurrence of illness, failure to understand or follow physician direction, or lack of follow-up care, among others. These readmissions significantly increase cost and utilization in this population, and are expected to increase with the projected growth in Medicare enrollment. The authors examined whether a postdischarge telephonic intervention for patients reduced 30-day hospital readmissions as compared to a matched control population. Postdischarge telephone calls were placed to patients after discharge from a hospital. Readmissions were monitored through health care claims data analysis. Of 48,538 Medicare members who received the intervention, 4504 (9.3%) were readmitted to the hospital within 30 days, as compared to 5598 controls (11.5%, P<0.0001). A direct correlation was observed between the timing of the intervention and the rate of readmission; the closer the intervention to the date of discharge the greater the reduction in number of readmissions. Furthermore, although emergency room visits were reduced in the intervention group as compared to controls (8.1% vs. 9.4%, P<0.0001), physician office visits increased (76.5% vs. 72.3%, P<0.0001), suggesting the intervention may have encouraged members to seek assistance leading to avoidance of readmission. As a group, overall cost savings were $499,458 for members who received the intervention, with $13,964,773 in savings to the health care plan. Support for patients after hospital discharge clearly affected hospital readmission and associated costs and warrants further development. (Population Health Management 2013;16:310–316) PMID:23537154

Office-based narrow band imaging-guided flexible laryngoscopy tissue sampling: A cost-effectiveness analysis evaluating its impact on Taiwanese health insurance program.

PubMed

Fang, Tuan-Jen; Li, Hsueh-Yu; Liao, Chun-Ta; Chiang, Hui-Chen; Chen, I-How

2015-07-01

Narrow band imaging (NBI)-guided flexible laryngoscopy tissue sampling for laryngopharyngeal lesions is a novel technique. Patients underwent the procedure in an office-based setting without being sedated, which is different from the conventional technique performed using direct laryngoscopy. Although the feasibility and effects of this procedure were established, its financial impact on the institution and Taiwanese National Health Insurance program was not determined. This is a retrospective case-control study. From May 2010 to April 2011, 20 consecutive patients who underwent NBI flexible laryngoscopy tissue sampling were recruited. During the same period, another 20 age-, sex-, and lesion-matched cases were enrolled in the control group. The courses for procedures and financial status were analyzed and compared between groups. Office-based NBI flexible laryngoscopy tissue sampling procedure took 27 minutes to be completed, while 191 minutes were required for the conventional technique. Average reimbursement for each case was New Taiwan Dollar (NT$)1264 for patients undergoing office-based NBI flexible laryngoscopy tissue sampling, while NT$10,913 for those undergoing conventional direct laryngoscopy in the operation room (p < 0.001). The institution suffered a loss of at least NT$690 when performing NBI flexible laryngoscopy tissue sampling. Office-based NBI flexible laryngoscopy tissue sampling is a cost-saving procedure for patients and the Taiwanese National Health Insurance program. It also saves the procedure time. However, the net financial loss for the institution and physician would limit its popularization unless reimbursement patterns are changed. Copyright © 2013. Published by Elsevier B.V.

Clinical and economic impact of infliximab one-hour infusion protocol in patients with inflammatory bowel diseases: A multicenter study

PubMed Central

Viola, Anna; Costantino, Giuseppe; Privitera, Antonino Carlo; Bossa, Fabrizio; Lauria, Angelo; Grossi, Laurino; Principi, Maria Beatrice; Della Valle, Nicola; Cappello, Maria

2017-01-01

AIM To assess the impact of short infliximab (IFX) infusion on hospital resource utilization and costs. METHODS All inflammatory bowel diseases (IBD) patients who received IFX 1 h infusion from March 2007 to September 2014 in eight centers from Southern Italy were included in the analysis. Demographic, clinical and infusion related data were collected. The potential benefits related to the short infusion protocol were assessed both in terms of time saving and increased infusion unit capacity. In addition, indirect patient-related cost savings were evaluated. RESULTS One hundred and twenty-five patients were recruited (64 with ulcerative colitis and 61 with Crohn’s disease). Median duration of disease was of 53 mo and mean age of pts at diagnosis was of 34 years (SD: ± 13). Adverse infusion reactions were reported in less than 4% both before and after short infusion. The total number of infusions across the selected centers was of 2501 (30.5% short infusions). In the analyzed cohort, 1143 h were saved (762 in the infusion and 381 in observation phases) through the rapid IFX infusion protocol. This time saving (-15% compared to the standard protocol in infusion phase) represents, from the hospital perspective, an opportunity to optimize infusion unit capacity by allocating the saved time in alternative cost-effective treatments. This is the case of opportunity cost that represents the value of forgone benefit which could be obtained from a resource in its next-best alternative use. Hence, an extra hour of infusion in the case of standard 2-h IFX represents a loss in opportunity to provide other cost effective services. The analysis showed that the short infusion increased the infusion units capacity up to 50% on days when the IFX infusions were scheduled (infusion phase). Furthermore, the analysis showed that the short IFX infusion protocol leads to time savings also in the post-infusion phase (observation) leading to a time saving of 10% on average among the analyzed centers. Finally, the short infusion protocol has been demonstrated to lead to indirect cost savings of €138/patient (average -€17.300 on the whole cohort). CONCLUSION A short IFX infusion protocol can be considered time and cost saving in comparison to the standard infusion protocol both from the hospital’s perspective, as it contributes to increase infusion units capacity, and the patients’ perspective, as it reduces indirect costs and the impact of treatment on everyday life and work productivity. PMID:28533923

Time- and cost-saving apparatus for analytical sample filtration

Treesearch

William R. Kenealy; Joseph C. Destree

2005-01-01

Simple and cost-effective protocols were developed for removing particulates from samples prior to analysis by high performance liquid chromatography and gas chromatography. A filter and vial holder were developed for use with a 96-well filtration plate. The device saves preparation time and costs.

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

Engelmeier, R.L.

A technique has been described for fabrication of a radiation therapy stent that can help to stabilize the head when adjustable alignment devices are used to position a patient during radiation therapy. The technique can save time for the radiotherapist, enhance accuracy in treatment, increase patient comfort, and save the dentist time in stent fabrication.

Spectral Analysis of the Effects of Daylight Saving Time on Motor Vehicle Fatal Traffic Accidents

DOT National Transportation Integrated Search

1977-04-01

This report shows that Daylight Saving Time (DST) reduces the number of persons killed in motor vehicle fatal traffic accidents by about one percent. This estimate is based on a spectral (Fourier) analysis of these fatalities which utilizes a filteri...

Operating room scheduling using hybrid clustering priority rule and genetic algorithm

NASA Astrophysics Data System (ADS)

Santoso, Linda Wahyuni; Sinawan, Aisyah Ashrinawati; Wijaya, Andi Rahadiyan; Sudiarso, Andi; Masruroh, Nur Aini; Herliansyah, Muhammad Kusumawan

2017-11-01

Operating room is a bottleneck resource in most hospitals so that operating room scheduling system will influence the whole performance of the hospitals. This research develops a mathematical model of operating room scheduling for elective patients which considers patient priority with limit number of surgeons, operating rooms, and nurse team. Clustering analysis was conducted to the data of surgery durations using hierarchical and non-hierarchical methods. The priority rule of each resulting cluster was determined using Shortest Processing Time method. Genetic Algorithm was used to generate daily operating room schedule which resulted in the lowest values of patient waiting time and nurse overtime. The computational results show that this proposed model reduced patient waiting time by approximately 32.22% and nurse overtime by approximately 32.74% when compared to actual schedule.

The effectiveness of the 55 MPH national maximum speed limit as a life saving benefit : executive summary

DOT National Transportation Integrated Search

1981-01-01

The following report contains an analysis of the life saving benefits resulting from the 55 mph NMSL from 1974-1979. Monthly fatality data from 1970-1979 was used in a time series model to arrive at the estimated safety benefits (lives saved). The ti...

Energy Savings Forecast of SSL in General Illumination Report Summary

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

None

2016-09-30

Summary of the DOE report Energy Savings Forecast of Solid-State Lighting in General Illumination Applications, a biannual report that models the adoption of LEDs in the U.S. general-lighting market, along with associated energy savings, based on the full potential DOE has determined to be technically feasible over time.

31 CFR 363.171 - How do I redeem a converted savings bond?

Code of Federal Regulations, 2014 CFR

2014-07-01

... converted savings bond? (a) Before final maturity—(1) Savings bond of any series registered in the single... bond of any series registered either in the single owner, owner with beneficiary, or entity form of registration any time prior to final maturity after the minimum holding period through your TreasuryDirect...

31 CFR 363.171 - How do I redeem a converted savings bond?

Code of Federal Regulations, 2011 CFR

2011-07-01

... converted savings bond? (a) Before final maturity—(1) Savings bond of any series registered in the single... bond of any series registered either in the single owner, owner with beneficiary, or entity form of registration any time prior to final maturity after the minimum holding period through your TreasuryDirect...

31 CFR 359.72 - May the United States supplement or amend the offering of Series I savings bonds?

Code of Federal Regulations, 2010 CFR

2010-07-01

... terms of this offering of Series I bonds at any time. ... amend the offering of Series I savings bonds? 359.72 Section 359.72 Money and Finance: Treasury... PUBLIC DEBT OFFERING OF UNITED STATES SAVINGS BONDS, SERIES I Miscellaneous Provisions § 359.72 May the...

31 CFR 359.72 - May the United States supplement or amend the offering of Series I savings bonds?

Code of Federal Regulations, 2011 CFR

2011-07-01

... terms of this offering of Series I bonds at any time. ... amend the offering of Series I savings bonds? 359.72 Section 359.72 Money and Finance: Treasury... PUBLIC DEBT OFFERING OF UNITED STATES SAVINGS BONDS, SERIES I Miscellaneous Provisions § 359.72 May the...

31 CFR 321.12 - Redemption value of securities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... value of each savings security is determined by the terms of its offering and the length of time it has been outstanding. The Bureau of the Fiscal Service determines redemption values for Series A-E bonds, eligible Series EE and I bonds, and savings notes, that should be used in redeeming savings securities. [63...

31 CFR 359.72 - May the United States supplement or amend the offering of Series I savings bonds?

Code of Federal Regulations, 2013 CFR

2013-07-01

... terms of this offering of Series I bonds at any time. ... amend the offering of Series I savings bonds? 359.72 Section 359.72 Money and Finance: Treasury... PUBLIC DEBT OFFERING OF UNITED STATES SAVINGS BONDS, SERIES I Miscellaneous Provisions § 359.72 May the...

31 CFR 363.171 - How do I redeem a converted savings bond?

Code of Federal Regulations, 2010 CFR

2010-07-01

... converted savings bond? (a) Before final maturity—(1) Savings bond of any series registered in the single... bond of any series registered either in the single owner, owner with beneficiary, or entity form of registration any time prior to final maturity after the minimum holding period through your TreasuryDirect...

31 CFR 363.171 - How do I redeem a converted savings bond?

Code of Federal Regulations, 2013 CFR

2013-07-01

... converted savings bond? (a) Before final maturity—(1) Savings bond of any series registered in the single... bond of any series registered either in the single owner, owner with beneficiary, or entity form of registration any time prior to final maturity after the minimum holding period through your TreasuryDirect...

31 CFR 363.171 - How do I redeem a converted savings bond?

Code of Federal Regulations, 2012 CFR

2012-07-01

... converted savings bond? (a) Before final maturity—(1) Savings bond of any series registered in the single... bond of any series registered either in the single owner, owner with beneficiary, or entity form of registration any time prior to final maturity after the minimum holding period through your TreasuryDirect...

31 CFR 359.72 - May the United States supplement or amend the offering of Series I savings bonds?

Code of Federal Regulations, 2012 CFR

2012-07-01

... terms of this offering of Series I bonds at any time. ... amend the offering of Series I savings bonds? 359.72 Section 359.72 Money and Finance: Treasury... PUBLIC DEBT OFFERING OF UNITED STATES SAVINGS BONDS, SERIES I Miscellaneous Provisions § 359.72 May the...

77 FR 42489 - Notice of Submission for OMB Review; Office of Postsecondary Education; Application for Gaining...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-19

... with the collection results from a program change to run this one-time college savings account...; Application for Gaining Early Awareness and Readiness for Undergraduate Programs (GEAR UP) College Savings... pairing federally supported college savings accounts with GEAR UP activities as part of an overall college...

Cloud field classification based upon high spatial resolution textural features. II - Simplified vector approaches

NASA Technical Reports Server (NTRS)

Chen, D. W.; Sengupta, S. K.; Welch, R. M.

1989-01-01

This paper compares the results of cloud-field classification derived from two simplified vector approaches, the Sum and Difference Histogram (SADH) and the Gray Level Difference Vector (GLDV), with the results produced by the Gray Level Cooccurrence Matrix (GLCM) approach described by Welch et al. (1988). It is shown that the SADH method produces accuracies equivalent to those obtained using the GLCM method, while the GLDV method fails to resolve error clusters. Compared to the GLCM method, the SADH method leads to a 31 percent saving in run time and a 50 percent saving in storage requirements, while the GLVD approach leads to a 40 percent saving in run time and an 87 percent saving in storage requirements.

Energy Savings in Cellular Networks Based on Space-Time Structure of Traffic Loads

NASA Astrophysics Data System (ADS)

Sun, Jingbo; Wang, Yue; Yuan, Jian; Shan, Xiuming

Since most of energy consumed by the telecommunication infrastructure is due to the Base Transceiver Station (BTS), switching off BTSs when traffic load is low has been recognized as an effective way of saving energy. In this letter, an energy saving scheme is proposed to minimize the number of active BTSs based on the space-time structure of traffic loads as determined by principal component analysis. Compared to existing methods, our approach models traffic loads more accurately, and has a much smaller input size. As it is implemented in an off-line manner, our scheme also avoids excessive communications and computing overheads. Simulation results show that the proposed method has a comparable performance in energy savings.

Household water saving: Evidence from Spain

NASA Astrophysics Data System (ADS)

Aisa, Rosa; Larramona, Gemma

2012-12-01

This article focuses on household water use in Spain by analyzing the influence of a detailed set of factors. We find that, although the presence of both water-saving equipment and water-conservation habits leads to water savings, the factors that influence each are not the same. In particular, our results show that those individuals most committed to the adoption of water-saving equipment and, at the same time, less committed to water-conservation habits tend to have higher incomes.

Assessment of operative times of multiple surgical specialties in a public university hospital

PubMed Central

Costa, Altair da Silva

2017-01-01

ABSTRACT Objective To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. Methods It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. Results The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. Conclusion This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. PMID:28767919

An assessment of the quality indicators of operative and non-operative times in a public university hospital

PubMed Central

Costa, Altair da Silva; Leão, Luiz Eduardo Villaça; de Novais, Maykon Anderson Pires; Zucchi, Paola

2015-01-01

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency. PMID:26761557

Net Zero Energy Manufactured Homes May Be on their Way

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

Gilbride, Theresa L.; Dentz, Jordan

This article, published in Home Energy Magazine, describes a research project sponsored by the U.S. Department of Energy's Building America program, to construct and test the first manufactured home in the United States built to the performance criteria of DOE's Zero Energy Ready Home program. A 15-month study was conducted to compare the real-world performance of the DOE Zero Energy Ready home and two other manufactured homes - one built to just above industry standard construction and one built to the ENERGY STAR Certified Home criteria. The homes were built by Clayton Homes' Southern Energy Division and testing was sponsoredmore » by DOE's Building America program and conducted by the Levy Partnership. The DOE ZERH had increased initial construction costs of $6,607 compared to the standard home versus $4,340 for the ENERGY STAR home but reduced energy bills by $50 per month compared to a $33/month savings for the ENERGY STAR home, and monthly savings will continue for the life of the home. Savings were especially noticeable in the summer in this cooling-dominated test location. The DOE ZERH cut cooling costs in half compared to the ENERGY STAR home which performed only slightly better than the standard home in summer, while winter savings between the two advanced homes were more similar. Two technology advances were tested in the DOE ZERH home. Instead of the typical ducted heating and cooling system, the DOE ZERH home was equipped with a ductless heat pump; to condition the bedroom, holes were cut into bedroom walls and small fans were installed to pull air into those rooms, while door undercuts and transfer grilles provide return paths. A novel dense-pack attic insulation was also implemented.« less

Cost Savings from Palliative Care Teams and Guidance for a Financially Viable Palliative Care Program

PubMed Central

McCarthy, Ian M; Robinson, Chessie; Huq, Sakib; Philastre, Martha; Fine, Robert L

2015-01-01

Objectives To quantify the cost savings of palliative care (PC) and identify differences in savings according to team structure, patient diagnosis, and timing of consult. Data Sources Hospital administrative records on all inpatient stays at five hospital campuses from January 2009 through June 2012. Study Design The analysis matched PC patients to non-PC patients (separately by discharge status) using propensity score methods. Weighted generalized linear model regressions of hospital costs were estimated for the matched groups. Data Collection Data were restricted to patients at least 18 years old with inpatient stays of between 7 and 30 days. Variables available included patient demographics, primary and secondary diagnoses, hospital costs incurred for the inpatient stay, and when/if the patient had a PC consult. Principal Findings We found overall cost savings from PC of $3,426 per patient for those dying in the hospital. No significant cost savings were found for patients discharged alive; however, significant cost savings for patients discharged alive could be achieved for certain diagnoses, PC team structures, or if consults occurred within 10 days of admission. Conclusions Appropriately selected and timed PC consults with physician and RN involvement can help ensure a financially viable PC program via cost savings to the hospital. PMID:25040226

31 CFR 359.72 - May the United States supplement or amend the offering of Series I savings bonds?

Code of Federal Regulations, 2014 CFR

2014-07-01

... amend the terms of this offering of Series I bonds at any time. ... amend the offering of Series I savings bonds? 359.72 Section 359.72 Money and Finance: Treasury... FISCAL SERVICE OFFERING OF UNITED STATES SAVINGS BONDS, SERIES I Miscellaneous Provisions § 359.72 May...

Optimal integration of daylighting and electric lighting systems using non-imaging optics

NASA Astrophysics Data System (ADS)

Scartezzini, J.-L.; Linhart, F.; Kaegi-Kolisnychenko, E.

2007-09-01

Electric lighting is responsible for a significant fraction of electricity consumption within non-residential buildings. Making daylight more available in office and commercial buildings can lead as a consequence to important electricity savings, as well as to the improvement of occupants' visual performance and wellbeing. Over the last decades, daylighting technologies have been developed for that purpose, some of them having proven to be highly efficient such as anidolic daylighting systems. Based on non-imaging optics these optical devices were designed to achieve an efficient collection and redistribution of daylight within deep office rooms. However in order to benefit from the substantial daylight provision obtained through these systems and convert it into effective electricity savings, novel electric lighting strategies are required. An optimal integration of high efficacy light sources and efficient luminaries based on non-imaging optics with anidolic daylighting systems can lead to such novel strategies. Starting from the experience gained through the development of an Anidolic Integrated Ceiling (AIC), this paper presents an optimal integrated daylighting and electric lighting system. Computer simulations based on ray-tracing techniques were used to achieve the integration of 36W fluorescent tubes and non-imaging reflectors with an advanced daylighting system. Lighting power densities lower than 4 W/m2 can be achieved in this way within the corresponding office room. On-site monitoring of an integrated daylighting and electric lighting system carried out on a solar experimental building confirmed the energy and visual performance of such a system: it showed that low lighting power densities can be achieved by combining an anidolic daylighting system with very efficient electric light sources and luminaries.

Saving billions of dollars--and physicians' time--by streamlining billing practices.

PubMed

Blanchfield, Bonnie B; Heffernan, James L; Osgood, Bradford; Sheehan, Rosemary R; Meyer, Gregg S

2010-06-01

The U.S. system of billing third parties for health care services is complex, expensive, and inefficient. Physicians end up using nearly 12 percent of their net patient service revenue to cover the costs of excessive administrative complexity. A single transparent set of payment rules for multiple payers, a single claim form, and standard rules of submission, among other innovations, would reduce the burden on the billing offices of physician organizations. On a national scale, our hypothetical modeling of these changes would translate into $7 billion of savings annually for physician and clinical services. Four hours of professional time per physician and five hours of practice support staff time could be saved each week.

Key Design Considerations When Calculating Cost Savings for Population Health Management Programs in an Observational Setting.

PubMed

Murphy, Shannon M E; Hough, Douglas E; Sylvia, Martha L; Dunbar, Linda J; Frick, Kevin D

2018-02-08

To illustrate the impact of key quasi-experimental design elements on cost savings measurement for population health management (PHM) programs. Population health management program records and Medicaid claims and enrollment data from December 2011 through March 2016. The study uses a difference-in-difference design to compare changes in cost and utilization outcomes between program participants and propensity score-matched nonparticipants. Comparisons of measured savings are made based on (1) stable versus dynamic population enrollment and (2) all eligible versus enrolled-only participant definitions. Options for the operationalization of time are also discussed. Individual-level Medicaid administrative and claims data and PHM program records are used to match study groups on baseline risk factors and assess changes in costs and utilization. Savings estimates are statistically similar but smaller in magnitude when eliminating variability based on duration of population enrollment and when evaluating program impact on the entire target population. Measurement in calendar time, when possible, simplifies interpretability. Program evaluation design elements, including population stability and participant definitions, can influence the estimated magnitude of program savings for the payer and should be considered carefully. Time specifications can also affect interpretability and usefulness. © Health Research and Educational Trust.

Spinning Reserve From Hotel Load Response: Initial Progress

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

Kueck, John D; Kirby, Brendan J

2008-11-01

This project was motivated by the fundamental match between hotel space conditioning load response capability and power system contingency response needs. As power system costs rise and capacity is strained demand response can provide a significant system reliability benefit at a potentially attractive cost. At ORNL s suggestion, Digital Solutions Inc. adapted its hotel air conditioning control technology to supply power system spinning reserve. This energy saving technology is primarily designed to provide the hotel operator with the ability to control individual room temperature set-points based upon occupancy (25% to 50% energy savings based on an earlier study [Kirby andmore » Ally, 2002]). DSI added instantaneous local load shedding capability in response to power system frequency and centrally dispatched load shedding capability in response to power system operator command. The 162 room Music Road Hotel in Pigeon Forge Tennessee agreed to host the spinning reserve test. The Tennessee Valley Authority supplied real-time metering equipment in the form of an internet connected Dranetz-BMI power quality meter and monitoring expertise to record total hotel load during both normal operations and test results. The Sevier County Electric System installed the metering. Preliminary testing showed that hotel load can be curtailed by 22% to 37% depending on the outdoor temperature and the time of day. These results are prior to implementing control over the common area air conditioning loads. Testing was also not at times of highest system or hotel loading. Full response occurred in 12 to 60 seconds from when the system operator s command to shed load was issued. The load drop was very rapid, essentially as fast as the 2 second metering could detect, with all units responding essentially simultaneously. Load restoration was ramped back in over several minutes. The restoration ramp can be adjusted to the power system needs. Frequency response testing was not completed. Initial testing showed that the units respond very quickly. Problems with local power quality generated false low frequency signals which required testing to be stopped. This should not be a problem in actual operation since the frequency trip points will be staggered to generate a droop curve which mimics generator governor response. The actual trip frequencies will also be low enough to avoid power quality problems. The actual trip frequencies are too low to generate test events with sufficient regularity to complete testing in a reasonable amount of time. Frequency response testing will resume once the local power quality problem is fully understood and reasonable test frequency settings can be determined. Overall the preliminary testing was extremely successful. The hotel response capability matches the power system reliability need, being faster than generation response and inherently available when the power system is under the most stress (times of high system and hotel load). Periodic testing is scheduled throughout the winter and spring to characterize hotel response capability under a full range of conditions. More extensive testing will resume when summer outdoor temperatures are again high enough to fully test hotel response.« less

Pressure Regulators as Valves for Saving Compressed Air and their Influence on System Dynamics

NASA Astrophysics Data System (ADS)

Dvořák, Lukáš; Fojtášek, Kamil

2015-05-01

Pressure regulators in the field of pneumatic mechanisms can be used as valves for saving compressed air. For example it can be used to reduce the pressure when the piston rod is retracting unloaded and thus it is possible to save some energy. However the problem is that saving valve can significantly affect the dynamics of the pneumatic system. The lower pressure in the piston rod chamber causes extension of time for retraction of the piston rod. This article compare the air consumption experimentally determined and calculated, measured curves of pressure in cylinder chambers and piston speed when saving valve is set up differently.

Improving employee productivity through improved health.

PubMed

Mitchell, Rebecca J; Ozminkowski, Ronald J; Serxner, Seth

2013-10-01

The objective of this study was to estimate productivity-related savings associated with employee participation in health promotion programs. Propensity score weighting and multiple regression techniques were used to estimate savings. These techniques were adjusted for demographic and health status differences between participants who engaged in one or more telephonic health management programs and nonparticipants who were eligible for but did not engage in these programs. Employees who participated in a program and successfully improved their health care or lifestyle showed significant improvements in lost work time. These employees saved an average of $353 per person per year. This reflects about 10.3 hours in additional productive time annually, compared with similar, but nonparticipating employees. Participating in health promotion programs can help improve productivity levels among employees and save money for their employers.

Outsourcing of Domestic Tasks and Time-Saving Effects

ERIC Educational Resources Information Center

van der Lippe, Tanja; Tijdens, Kea; de Ruijter, Esther

2004-01-01

The increased participation of women in paid labor has changed the organization of domestic work. This article deals with a strategy to cope with remaining domestic duties; to what extent are domestic tasks outsourced, what are the main determinants, and does it indeed save time spent on housework? Five outsourcing options are investigated:…

Evaluation of optimum room entry times for radiation therapists after high energy whole pelvic photon treatments.

PubMed

Ho, Lavine; White, Peter; Chan, Edward; Chan, Kim; Ng, Janet; Tam, Timothy

2012-01-01

Linear accelerators operating at or above 10 MV produce neutrons by photonuclear reactions and induce activation in machine components, which are a source of potential exposure for radiation therapists. This study estimated gamma dose contributions to radiation therapists during high energy, whole pelvic, photon beam treatments and determined the optimum room entry times, in terms of safety of radiation therapists. Two types of technique (anterior-posterior opposing and 3-field technique) were studied. An Elekta Precise treatment system, operating up to 18 MV, was investigated. Measurements with an area monitoring device (a Mini 900R radiation monitor) were performed, to calculate gamma dose rates around the radiotherapy facility. Measurements inside the treatment room were performed when the linear accelerator was in use. The doses received by radiation therapists were estimated, and optimum room entry times were determined. The highest gamma dose rates were approximately 7 μSv/h inside the treatment room, while the doses in the control room were close to background (~0 μSv/h) for all techniques. The highest personal dose received by radiation therapists was estimated at 5 mSv/yr. To optimize protection, radiation therapists should wait for up to11 min after beam-off prior to room entry. The potential risks to radiation therapists with standard safety procedures were well below internationally recommended values, but risks could be further decreased by delaying room entry times. Dependent on the technique used, optimum entry times ranged between 7 to 11 min. A balance between moderate treatment times versus reduction in measured equivalent doses should be considered.

Impact of the Removal of the Monthly Liver Function Test Requirement for Ambrisentan

PubMed Central

Durst, Louise A.; Carlsen, John; Kuchinski, Megan; Harner, Lauren; Neves, Daniel; Harris, Stephanie J.; Traiger, Glenna L.

2012-01-01

Background The management of patients with pulmonary arterial hypertension (PAH) requires extensive coordination between patients, their support system, third-party payers, and healthcare professionals. For patients with PAH who are receiving endothelin receptor antagonists (ERAs), such cross-stakeholder coordination was needed to ensure compliance with a US Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) requirement for monthly liver function tests (LFTs). In March 2011, the FDA removed this requirement for ambrisentan (Letairis) in conjunction with a change to the product label. Objective This study sought to explore the impact of the ambrisentan label change on payers, providers who treat PAH, and specialty pharmacies. Methods This study, conducted in June and July 2011, involved telephone interviews with 5 medical/pharmacy directors in commercial health plans (representing 78,345,000 covered lives collectively); written surveys and telephone interviews with 6 nurses managing patients with PAH; and written surveys and telephone interviews with 4 staff members from specialty pharmacies to determine direct and indirect cost-savings associated with the removal of the monthly LFT requirement for ambrisentan. Qualitative telephone interviews with payer decision makers informed the cost-savings for payers. Direct cost-savings were calculated from the responses of the nurses managing PAH regarding the prescribing trends of their practices and the frequency of LFTs. Indirect cost-savings were calculated using time-savings data collected from the PAH-managing nurses and the specialty pharmacy staff, as well as from the US Bureau of Labor Statistics data regarding national wage averages for the respective staff. Results: Payers reported that REMS requirements did not play a large role in their plan's coverage or management of ERAs; although direct cost-savings resulting from the label change were an estimated $28 per patient per month, this amount is relatively small compared with the overall cost of PAH treatment for payers. The impact of the ambrisentan label change was more significant for providers and specialty pharmacies. The label change resulted in a significant, average 69% reduction in the frequency of LFTs for patients using ambrisentan. The average monthly time-savings realized by providers as a result of the label change was 12 minutes per patient receiving ambrisentan, and the average monthly direct and indirect cost-savings totaled $10.75 and $29.75, respectively, per patient taking ambrisentan. Telephone interviews with specialty pharmacies indicated that the average monthly time-savings for the 4 specialty pharmacies surveyed was 14 minutes per patient using ambrisentan, representing an 86.7% decrease in the amount of time specialty pharmacies spent on LFT-related administrative tasks for patients using ambrisentan. Conclusion Findings from this study indicate that the ambrisentan label change significantly reduced the number of LFTs for patients with PAH, resulting in time-savings or cost-savings for payers, providers, and specialty pharmacies. PMID:24991314

Sick child care options: what do working mothers prefer?

PubMed

Landis, S E; Earp, J A

1987-01-01

More than half of all mothers with children under age 6 are in the labor force. Working mothers must take off anywhere from 5.6 days to 28.8 days per employee per year to care for their sick children. In a survey of 134 working mothers with children in day care centers, 70% expressed an interest in sick child care options outside the home, especially a sick room at the child's regular day care center or an infirmary at the parent's workplace. Mothers who chose "out-of home care" were more likely to: be minority (p less than 0.01); be single parents (p = 0.06); earn less than $10,000 annually (p = 0.03); want their children with temperatures of 100-100.9 F to remain in school until the end of the day (p less than 0.01). Communities and day care centers serving especially lower income, minority or single-parent working mothers should consider investigating these out-of-home sick child care options; the savings to employers could be $2 to $12 billion per year, not to speak of the personal savings to the mothers themselves.

Expanding potential of radiofrequency nurse call systems to measure nursing time in patient rooms.

PubMed

Fahey, Linda; Dunn Lopez, Karen; Storfjell, Judith; Keenan, Gail

2013-05-01

The objective of this study was to determine the utility and feasibility of using data from a nurse call system equipped with radiofrequency identification data (RFID) to measure nursing time spent in patient rooms. Increasing the amount of time nurses spend with hospitalized patients has become a focus after several studies demonstrating that nurses spend most of their time in nondirect care activities rather than delivering patient care. Measurement of nursing time spent in direct care often involves labor-intensive time and motion studies, making frequent or continuous monitoring impractical. Mixed methods were used for this descriptive study. We used 30 days of data from an RFID nurse call system collected on 1 unit in a community hospital to examine nurses time spent in patient rooms. Descriptive statistics were applied to calculate this percentage by role and shift. Data technologists were surveyed to assess how practical the access of data would be in a hospital setting for use in monitoring nursing time spent in patient rooms. The system captured 7393 staff hours. Of that time, 7% did not reflect actual patient care time, so these were eliminated from further analysis. The remaining 6880 hours represented 91% of expected worked time. RNs and nursing assistants spent 33% to 36% of their time in patient rooms, presumably providing direct care. Radiofrequency identification data technology was found to provide feasible and accurate means for capturing and evaluating nursing time spent in patient rooms. Depending on the outcomes per unit, leaders should work with staff to maximize patient care time.

A cost/benefit analysis of commercial fusion-fission hybrid reactor development

NASA Astrophysics Data System (ADS)

Kostoff, Ronald N.

1983-04-01

A simple algorithm was developed that allows rapid computation of the ratio, R, of present worth of benefits to present worth of hybrid R&D program costs as a function of potential hybrid unit electricity cost savings, discount rate, electricity demand growth rate, total hybrid R&D program cost, and time to complete a demonstration reactor. In the sensitivity study, these variables were assigned nominal values (unit electricity cost savings of 4 mills/kW-hr, discount rate of 4%/year, growth rate of 2.25%/year, total R&D program cost of 20 billion, and time to complete a demonstration reactor of 30 years), and the variable of interest was varied about its nominal value. Results show that R increases with decreasing discount rate and increasing unit electricity savings and ranges from 4 to 94 as discount rate ranges from 5 to 3%/year and unit electricity savings range from 2 to 6 mills/kW-hr. R increases with increasing growth rate and ranges from 3 to 187 as growth rate ranges from 1 to 3.5%/year and unit electricity cost savings range from 2 to 6 mills/kW-hr. R attains a maximum value when plotted against time to complete a demonstration reactor. The location of this maximum value occurs at shorter completion times as discount rate increases, and this optimal completion time ranges from 20 years for a discount rate of 4%/year to 45 years for a discount rate of 3%/year.

Experience using radio frequency laptops to access the electronic medical record in exam rooms.

PubMed Central

Dworkin, L. A.; Krall, M.; Chin, H.; Robertson, N.; Harris, J.; Hughes, J.

1999-01-01

Kaiser Permanente, Northwest, evaluated the use of laptop computers to access our existing comprehensive Electronic Medical Record in exam rooms via a wireless radiofrequency (RF) network. Eleven of 22 clinicians who were offered the laptops successfully adopted their use in the exam room. These clinicians were able to increase their exam room time with the patient by almost 4 minutes (25%), apparently without lengthening their overall work day. Patient response to exam room computing was overwhelmingly positive. The RF network response time was similar to the hardwired network. Problems cited by some laptop users and many of the eleven non-adopters included battery issues, different equipment layout and function, and inadequate training. IT support needs for the RF laptops were two to four times greater than for hardwired desktops. Addressing the reliability and training issues should increase clinician acceptance, making a successful general roll-out for exam room computing more likely. PMID:10566458

Special ISO Class 6 Cleanroom for the Lunar Reconnaissance Orbiter (LRO) Project

NASA Technical Reports Server (NTRS)

Matthews, Richard A.; Matthews, Scott A.

2008-01-01

The parameters and restrictions for a horizontal flow ISO Class 6 Clean room to support the assembly of the new LRO (Lunar Reconnaissance Orbiter) were unusual. The project time line was critical. A novel Clean room design was developed and built within the time restraints. This paper describes the design criteria, timing, successful performance, and future benefits of this unique Clean room project.

Grid Computing and Collaboration Technology in Support of Fusion Energy Sciences

NASA Astrophysics Data System (ADS)

Schissel, D. P.

2004-11-01

The SciDAC Initiative is creating a computational grid designed to advance scientific understanding in fusion research by facilitating collaborations, enabling more effective integration of experiments, theory and modeling, and allowing more efficient use of experimental facilities. The philosophy is that data, codes, analysis routines, visualization tools, and communication tools should be thought of as easy to use network available services. Access to services is stressed rather than portability. Services share the same basic security infrastructure so that stakeholders can control their own resources and helps ensure fair use of resources. The collaborative control room is being developed using the open-source Access Grid software that enables secure group-to-group collaboration with capabilities beyond teleconferencing including application sharing and control. The ability to effectively integrate off-site scientists into a dynamic control room will be critical to the success of future international projects like ITER. Grid computing, the secure integration of computer systems over high-speed networks to provide on-demand access to data analysis capabilities and related functions, is being deployed as an alternative to traditional resource sharing among institutions. The first grid computational service deployed was the transport code TRANSP and included tools for run preparation, submission, monitoring and management. This approach saves user sites from the laborious effort of maintaining a complex code while at the same time reducing the burden on developers by avoiding the support of a large number of heterogeneous installations. This tutorial will present the philosophy behind an advanced collaborative environment, give specific examples, and discuss its usage beyond FES.

Looking at IT through a New Lens: Achieving Cost Savings in a Fiscally Challenging Time

ERIC Educational Resources Information Center

Claffey, George F., Jr.

2009-01-01

Information technology (IT) departments must cut costs and justify expenditures in the face of shrinking budgets. To promote greater cost savings, it is important to look at IT through a new "lens." This article discusses four broad categories that can be evaluated to determine if IT resource alignment is appropriate and if savings can…

12 CFR 391.13 - Issuance of orders to correct deficiencies and to take or refrain from taking other actions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... general. The FDIC shall provide a State savings association prior written notice of the FDIC's intention to issue an order requiring the State savings association to correct a safety and soundness... savings association shall have such time to respond to a proposed order as provided by the FDIC under...

12 CFR 391.13 - Issuance of orders to correct deficiencies and to take or refrain from taking other actions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... general. The FDIC shall provide a State savings association prior written notice of the FDIC's intention to issue an order requiring the State savings association to correct a safety and soundness... savings association shall have such time to respond to a proposed order as provided by the FDIC under...

12 CFR 391.13 - Issuance of orders to correct deficiencies and to take or refrain from taking other actions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... general. The FDIC shall provide a State savings association prior written notice of the FDIC's intention to issue an order requiring the State savings association to correct a safety and soundness... savings association shall have such time to respond to a proposed order as provided by the FDIC under...

A procedure for rapid issue of red cells for emergency use.

PubMed

Weiskopf, Richard B; Webb, Mary; Stangle, Deena; Klinbergs, Gunter; Toy, Pearl

2005-04-01

A College of American Pathologists Q-Probe revealed that the median turnaround times for emergency requests for red blood cells from the operating room were 30 minutes to release of cells from the blood bank and 34 minutes to delivery to the operating room. These times may not be adequate to permit the red cells to provide sufficiently rapid delivery of oxygen in massively bleeding patients. To improve the time from emergency request for red cells to delivery to the operating room. A new emergency issue program was implemented for only the operating rooms; emergency issue to all other hospital locations remained unchanged. Six units of group O Rh-negative red blood cells (RBCs) are maintained in the blood bank in a separate basket with transfusion forms containing the unit numbers and expiration dates and a bag with one blood tubing segment from each unit. The times to issue and to delivery to the operating room suite were compared with time to issue of 2 group O Rh-negative RBCs for other hospital locations using the older system during the same time period and with the time to issue of 2 units to all other hospital locations during the preceding 2 years. A university hospital. Time between emergency request for red cells and delivery to the operating room. The time between blood bank notification and arrival in the operating room of the 6 units of RBCs was significantly shorter than the time required to just issue (not including delivery time) 2 units of RBCs to other hospital locations. With the new procedure, 82% of units issued reached the operating room within 2 minutes of request, 91% arrived within 3 minutes, and 100% arrived within 4 minutes. These percentages are significantly higher than those for only issue of blood (without delivery) using the older issuing procedure for all hospital locations during the previous 2 years (37%, 49%, and 66%, respectively; P = .007, .009, and .02, respectively) and for other locations during the same 7-month period (29%, 46%, and 73%, respectively; P = .004, .01, and .09, respectively). Time (mean [95% confidence interval]) from blood bank notification to delivery of RBCs to the operating room suite (2.1 [1.6-2.6] minutes, of which approximately 50-60 seconds is attributable to delivery time) was less than issue times (not including delivery times) using the older issuing procedure for other hospital locations during the same period (4.1 [3.1-5.0] minutes; P = .007). An emergency issue procedure can be used to issue several units of RBCs within 1 minute and have them delivered to the operating room within 2 minutes while maintaining sufficient controls and providing required information to satisfy patient and blood bank requirements.

Avoiding Medical Identity Theft

MedlinePlus

... was not received, even when there is no money owed Maintain copies of your healthcare records Beware ... learned that a PHR saves time, energy, and money. And it saved my life! A woman's Facebook ...

Expanding primary care capacity by reducing waste and improving the efficiency of care.

PubMed

Shipman, Scott A; Sinsky, Christine A

2013-11-01

Most solutions proposed for the looming shortage of primary care physicians entail strategies that fall into one of three categories: train more, lose fewer, or find someone else. A fourth strategy deserves more attention: waste less. This article examines the remarkable inefficiency and waste in primary care today and highlights practices that have addressed these problems. For example, delegating certain administrative tasks such as managing task lists in the electronic health record can give physicians more time to see additional patients. Flow managers who guide physicians from task to task throughout the clinical day have been shown to improve physicians' efficiency and capacity. Even something as simple as placing a printer in every exam room can save each physician twenty minutes per day. Modest but systemwide improvements could yield dramatic gains in physician capacity while potentially reducing physician burnout and its implications for the quality of care. If widely adopted, small efforts to empower nonphysicians, reengineer workflows, exploit technology, and update policies to eliminate wasted effort could yield the capacity for millions of additional patient visits per year in the United States.

Designing a dormitory with emphasis on renewable energy

NASA Astrophysics Data System (ADS)

Daneshvar Tarigh, F.; Daneshvar Tarigh, A.; Habib, F.

2018-05-01

The majority of universities provides on- and off-campus residential quarters for students during their studies which enables them to keep connected to other students and focus on their studies usually with a small amount of money. The manner of designing a dormitory has a direct impact on the performance of the students and therefore requires a lot of attention. This includes but not limited to a mostly independent and private quiet room maintaining good indoor air quality through adequate ventilation and air conditioning. Undoubtedly, the most important aspect of such a place is saving energy in a way that does not influence the quality of student's life. The type of usage of such buildings causes different presence time and different ideas about the lights and temperature's set point. In this paper, we will discuss aspects of designing a dormitory as well as optimization of occupants comfort and energy efficiency using renewable energies such as solar energy to produce electricity, wind energy for natural ventilation and above all using architectural techniques to lower the energy consumption.

Double-label immunofluorescence method for simultaneous detection of adenovirus and herpes simplex virus from the eye.

PubMed

Walpita, P; Darougar, S

1989-07-01

The development and application of a double-label immunofluorescence method which has the potential to screen for single or dual infections from any site, in single shell vial cultures, is described. In this study, a total of 1,141 ocular specimens were inoculated in shell vials, centrifuged at 15,000 X g for 1 h, incubated at 37 degrees C for 48 h, and fixed in methanol at room temperature for 15 min. The virus inclusions were detected by staining with a double-label indirect immunofluorescence procedure using mixtures of appropriate first antibodies, followed by fluorescein- and rhodamine-conjugated second antibodies. Each specimen was also inoculated in parallel by the conventional virus isolation method. The sensitivity and specificity of the double-label shell vial procedure were comparable to those with the conventional method, and the former test took only 48 h to complete. The test offers a rapid and simple single-vial procedure which allows for individual or simultaneous detection of multiple pathogens. It results in savings in time and cost over the conventional virus isolation method and other shell vial procedures.

Resuscitation great. George W. Crile: a visionary mind in resuscitation.

PubMed

Soto-Ruiz, Karina M; Varon, Joseph

2009-01-01

George Washington Crile was a successful surgeon who lived at the end of the 19th century. He was born on 11 November 1864 on a farm near Chili, Ohio. He became interested in the study of shock after a close friend died from hemorrhage. Crile dedicated his research years to the study of shock, cardiac arrest, and the use of adrenaline. His research on shock and cardiac arrest led to treatment guidelines that are still used today. He also participated in the Spanish-American War and in World War I as a Navy Surgeon and saved the lives of many soldiers with his principles of blood transfusion and sanitation. He is also known in the surgical world as the grandfather of radical neck dissection and received the Gold Lannelongue Medal and prize. Having written over 400 papers and 24 books, George W. Crile died from complications of bacterial endocarditis on 7th January 1943. Although they were published a long time ago, his contributions to medicine remain fundamental to clinical practice in today's operating rooms and critical care units.

Smart HVAC Control in IoT: Energy Consumption Minimization with User Comfort Constraints

PubMed Central

Verikoukis, Christos

2014-01-01

Smart grid is one of the main applications of the Internet of Things (IoT) paradigm. Within this context, this paper addresses the efficient energy consumption management of heating, ventilation, and air conditioning (HVAC) systems in smart grids with variable energy price. To that end, first, we propose an energy scheduling method that minimizes the energy consumption cost for a particular time interval, taking into account the energy price and a set of comfort constraints, that is, a range of temperatures according to user's preferences for a given room. Then, we propose an energy scheduler where the user may select to relax the temperature constraints to save more energy. Moreover, thanks to the IoT paradigm, the user may interact remotely with the HVAC control system. In particular, the user may decide remotely the temperature of comfort, while the temperature and energy consumption information is sent through Internet and displayed at the end user's device. The proposed algorithms have been implemented in a real testbed, highlighting the potential gains that can be achieved in terms of both energy and cost. PMID:25054163

Smart HVAC control in IoT: energy consumption minimization with user comfort constraints.

PubMed

Serra, Jordi; Pubill, David; Antonopoulos, Angelos; Verikoukis, Christos

2014-01-01

Smart grid is one of the main applications of the Internet of Things (IoT) paradigm. Within this context, this paper addresses the efficient energy consumption management of heating, ventilation, and air conditioning (HVAC) systems in smart grids with variable energy price. To that end, first, we propose an energy scheduling method that minimizes the energy consumption cost for a particular time interval, taking into account the energy price and a set of comfort constraints, that is, a range of temperatures according to user's preferences for a given room. Then, we propose an energy scheduler where the user may select to relax the temperature constraints to save more energy. Moreover, thanks to the IoT paradigm, the user may interact remotely with the HVAC control system. In particular, the user may decide remotely the temperature of comfort, while the temperature and energy consumption information is sent through Internet and displayed at the end user's device. The proposed algorithms have been implemented in a real testbed, highlighting the potential gains that can be achieved in terms of both energy and cost.

Rapid room-temperature synthesis of nanocrystalline spinels as oxygen reduction and evolution electrocatalysts.

PubMed

Cheng, Fangyi; Shen, Jian; Peng, Bo; Pan, Yuede; Tao, Zhanliang; Chen, Jun

2011-01-01

Spinels can serve as alternative low-cost bifunctional electrocatalysts for oxygen reduction/evolution reactions (ORR/OER), which are the key barriers in various electrochemical devices such as metal-air batteries, fuel cells and electrolysers. However, conventional ceramic synthesis of crystalline spinels requires an elevated temperature, complicated procedures and prolonged heating time, and the resulting product exhibits limited electrocatalytic performance. It has been challenging to develop energy-saving, facile and rapid synthetic methodologies for highly active spinels. In this Article, we report the synthesis of nanocrystalline M(x)Mn(3-x)O(4) (M = divalent metals) spinels under ambient conditions and their electrocatalytic application. We show rapid and selective formation of tetragonal or cubic M(x)Mn(3-x)O(4) from the reduction of amorphous MnO(2) in aqueous M(2+) solution. The prepared Co(x)Mn(3-x)O(4) nanoparticles manifest considerable catalytic activity towards the ORR/OER as a result of their high surface areas and abundant defects. The newly discovered phase-dependent electrocatalytic ORR/OER characteristics of Co-Mn-O spinels are also interpreted by experiment and first-principle theoretical studies.

[Is Herceptin(®) (trastuzumab) by subcutaneous a mini revolution? Pharmaco-economic study].

PubMed

Lieutenant, Vincent; Toulza, Émilie; Pommier, Martine; Lortal-Canguilhem, Barbara

2015-03-01

Herceptin(®) injected by intravenous (IV) is one of the key treatment of breast cancer HER2+. The improvement of galenic form allowed a new way of administration, the sub-cutaneous way (SC), authorized by EMEA in 2013. This new way enables a 5-minute infusion, a fixed dose and a fixed volume of preparation. On 2012, saving-time and financial impacts were calculated by extrapolation of the IV way in a cancer treatment center. The study showed a preparing time-saving of 7.5min/loading dose and of 6.5min/maintenance dose, and a nurse time-saving of 4.5min/loading dose and 4.25min/maintenance dose. Moreover, it can be added a saving of consumable of 13,31€ per injection in case of monotherapy. The SC leads to a new adaptation and reorganization in the preparation of monoclonal antibodies and day hospitals. Copyright © 2015 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Ways to reduce patient turnaround time and improve service quality in emergency departments.

PubMed

Sinreich, David; Marmor, Yariv

2005-01-01

Recent years have witnessed a fundamental change in the function of emergency departments (EDs). The emphasis of the ED shifts from triage to saving the lives of shock-trauma rooms equipped with state-of-the-art equipment. At the same time walk-in clinics are being set up to treat ambulatory type patients. Simultaneously ED overcrowding has become a common sight in many large urban hospitals. This paper recognises that in order to provide quality treatment to all these patient types, ED process operations have to be flexible and efficient. The paper aims to examine one major benchmark for measuring service quality--patient turnaround time, claiming that in order to provide the quality treatment to which EDs aspire, this time needs to be reduced. This study starts by separating the process each patient type goes through when treated at the ED into unique components. Next, using a simple model, the impact each of these components has on the total patient turnaround time is determined. This in turn, identifies the components that need to be addressed if patient turnaround time is to be streamlined. The model was tested using data that were gathered through a comprehensive time study in six major hospitals. The analysis reveals that waiting time comprises 51-63 per cent of total patient turnaround time in the ED. Its major components are: time away for an x-ray examination; waiting time for the first physician's examination; and waiting time for blood work. The study covers several hospitals and analyses over 20,000 process components; as such the common findings may serve as guidelines to other hospitals when addressing this issue.

The impact of a preloaded intraocular lens delivery system on operating room efficiency in routine cataract surgery.

PubMed

Jones, Jason J; Chu, Jeffrey; Graham, Jacob; Zaluski, Serge; Rocha, Guillermo

2016-01-01

The aim of this study was to evaluate the operational impact of using preloaded intraocular lens (IOL) delivery systems compared with manually loaded IOL delivery processes during routine cataract surgeries. Time and motion data, staff and surgery schedules, and cost accounting reports were collected across three sites located in the US, France, and Canada. Time and motion data were collected for manually loaded IOL processes and preloaded IOL delivery systems over four surgery days. Staff and surgery schedules and cost accounting reports were collected during the 2 months prior and after introduction of the preloaded IOL delivery system. The study included a total of 154 routine cataract surgeries across all three sites. Of these, 77 surgeries were performed using a preloaded IOL delivery system, and the remaining 77 surgeries were performed using a manual IOL delivery process. Across all three sites, use of the preloaded IOL delivery system significantly decreased mean total case time by 6.2%-12.0% (P<0.001 for data from Canada and the US and P<0.05 for data from France). Use of the preloaded delivery system also decreased surgeon lens time, surgeon delays, and eliminated lens touches during IOL preparation. Compared to a manual IOL delivery process, use of a preloaded IOL delivery system for cataract surgery reduced total case time, total surgeon lens time, surgeon delays, and eliminated IOL touches. The time savings provided by the preloaded IOL delivery system provide an opportunity for sites to improve routine cataract surgery throughput without impacting surgeon or staff capacity.

Noise in neonatal intensive care units (NICUs) and its effect on high risk newborns

NASA Astrophysics Data System (ADS)

Lasky, Robert E.; Williams, Amber L.; van Drongelen, Wim; Gray, Lincoln C.

2005-09-01

We conducted sound surveys in a large state of the art NICU with six separate rooms devoted to the sickest babies requiring the most intensive care (Level III) and six rooms devoted to babies requiring special but less intensive care (Level II). Each room was capable of caring for up to 8 babies. Additionally, there were 8 individual Isolation rooms. We used Larson Davis Spark squflg 703+ dosimeters to record 21 week long sound surveys, seven in each type of room. The American Academy of Pediatrics (1997) has recommended that sound levels in NICUs should never exceed 45 dB(A). That recommendation was exceeded 73.6% of the time in Level II, 92.1% of the time in Isolation, and 96.6% of the time in Level III. Sound levels were lowest in the Level II rooms especially for the softest sounds recorded (L90 and L70). Level III rooms were noisiest except for the noisiest decile of sound (L10). Isolation rooms were noisiest at the highest sound levels (probably because of their reverberant construction materials and enclosed space). Autocorrelation functions were calculated identifying periodic components in all three rooms at about 12 and 24 hrs. Periodic variations were very small compared to random sound variations.

Information for Caregivers

MedlinePlus

... learned that a PHR saves time, energy, and money. And it saved my life! A woman's Facebook ... Doctor’s Visit A Reference Guide Blue Button Resources Mobile PHRs Blog FAQ © 2018 AHIMA, All Rights Reserved | ...

Common Privacy Myths

MedlinePlus

... learned that a PHR saves time, energy, and money. And it saved my life! A woman's Facebook ... Doctor’s Visit A Reference Guide Blue Button Resources Mobile PHRs Blog FAQ © 2018 AHIMA, All Rights Reserved | ...

Performance analysis of male handball goalkeepers at the World Handball championship 2015

PubMed Central

Hansen, Clint; Sanz-Lopez, Fernando; Whiteley, Rodney; Popovic, Nebojsa; Ahmed, Hosny Abdelrahman

2017-01-01

Goalkeepers have a very important role in handball. In coaching communities it is well recognized that goalkeepers’ performances can predict team ranking in major tournaments. Despite this, few studies have been conducted on elite goalkeepers participating in World Championships. Therefore, the purpose of this study was to analyse goalkeepers’ save performance during the 88 matches of the 2015 men’s World Championships tournament. Goalkeepers from 24 national teams were analysed using a tracking camera system and bespoke software (Prozone Handball V.1.2, Prozone, Leeds, UK). The purpose of this study was to examine time-motion performance parameters and to evaluate the save rates for each goalkeeper. The mean total distance covered in a game by the goalkeepers was 1634±999 m. Goalkeepers spent most of the time walking or standing. The total amount of shots to the goal was 6893, with a mean save percentage of 30% (2088 saves). A significant relationship was identified between the goalkeepers’ save statistics and the final team rankings. The save rate is important for teams to achieve a higher ranking, and therefore the selection and training of goalkeepers requires more than just assessing physical abilities. The throwing distribution and success/save rate during the Qatar 2015 Men Handball World Championships suggest strong and weak parts of the goal area, and coaches can use this information to adjust their training approaches for both goalkeepers and shooters. PMID:29472743

Performance analysis of male handball goalkeepers at the World Handball championship 2015.

PubMed

Hansen, Clint; Sanz-Lopez, Fernando; Whiteley, Rodney; Popovic, Nebojsa; Ahmed, Hosny Abdelrahman; Cardinale, Marco

2017-12-01

Goalkeepers have a very important role in handball. In coaching communities it is well recognized that goalkeepers' performances can predict team ranking in major tournaments. Despite this, few studies have been conducted on elite goalkeepers participating in World Championships. Therefore, the purpose of this study was to analyse goalkeepers' save performance during the 88 matches of the 2015 men's World Championships tournament. Goalkeepers from 24 national teams were analysed using a tracking camera system and bespoke software (Prozone Handball V.1.2, Prozone, Leeds, UK). The purpose of this study was to examine time-motion performance parameters and to evaluate the save rates for each goalkeeper. The mean total distance covered in a game by the goalkeepers was 1634±999 m. Goalkeepers spent most of the time walking or standing. The total amount of shots to the goal was 6893, with a mean save percentage of 30% (2088 saves). A significant relationship was identified between the goalkeepers' save statistics and the final team rankings. The save rate is important for teams to achieve a higher ranking, and therefore the selection and training of goalkeepers requires more than just assessing physical abilities. The throwing distribution and success/save rate during the Qatar 2015 Men Handball World Championships suggest strong and weak parts of the goal area, and coaches can use this information to adjust their training approaches for both goalkeepers and shooters.

Adaptive model-predictive controller for magnetic resonance guided focused ultrasound therapy.

PubMed

de Bever, Joshua; Todd, Nick; Payne, Allison; Christensen, Douglas A; Roemer, Robert B

2014-11-01

Minimising treatment time and protecting healthy tissues are conflicting goals that play major roles in making magnetic resonance image-guided focused ultrasound (MRgFUS) therapies clinically practical. We have developed and tested in vivo an adaptive model-predictive controller (AMPC) that reduces treatment time, ensures safety and efficacy, and provides flexibility in treatment set-up. The controller realises time savings by modelling the heated treatment cell's future temperatures and thermal dose accumulation in order to anticipate the optimal time to switch to the next cell. Selected tissues are safeguarded by a configurable temperature constraint. Simulations quantified the time savings realised by each controller feature as well as the trade-offs between competing safety and treatment time parameters. In vivo experiments in rabbit thighs established the controller's effectiveness and reliability. In all in vivo experiments the target thermal dose of at least 240 CEM43 was delivered everywhere in the treatment volume. The controller's temperature safety limit reliably activated and constrained all protected tissues to <9 CEM43. Simulations demonstrated the path independence of the controller, and that a path which successively proceeds to the hottest untreated neighbouring cell leads to significant time savings, e.g. when compared to a concentric spiral path. Use of the AMPC produced a compounding time-saving effect; reducing the treatment cells' heating times concurrently reduced heating of normal tissues, which eliminated cooling periods. Adaptive model-predictive control can automatically deliver safe, effective MRgFUS treatments while significantly reducing treatment times.

Impact of spinal anesthesia for open pyloromyotomy on operating room time.

PubMed

Kachko, Ludmyla; Simhi, Eliahu; Freud, Enrique; Dlugy, Elena; Katz, Jacob

2009-10-01

When pyloromyotomy for hypertrophic pyloric stenosis (HPS) is performed under general anesthesia, metabolic abnormalities and fluid deficits coupled with residual anesthetics may increase the risk of postoperative apnea, thereby, prolonging operating room time and delaying extubation. Spinal anesthesia has been found to reduce the rate of postoperative apnea in high-risk infants. The aim of the study was to evaluate the effect of spinal vs general anesthesia on operating room time in infants undergoing open pyloromyotomy. Data for 60 infants who underwent pyloromyotomy under spinal (n = 24) or general (n = 36) anesthesia at a tertiary pediatric medical center were derived from the computerized database. Primary outcome measures were total operating room time, procedure duration, anesthesia release time, wake-up time, and anesthesia control time (anesthesia release plus wake-up). Nonparametric Mann-Whitney test was used for statistical analysis, and Levene's test was used to assess the equality of variances in samples; P

Change in the Classroom Deportment of Children Following Change From Daylight Saving Time.

ERIC Educational Resources Information Center

Hicks, Robert A.; And Others

1980-01-01

The deportment of each student in a third-grade classroom was rated by the teacher before and after the fall change from daylight savings time, to see if this disruption in circadian rhythms alters behavior. The deportment of boys improved significantly while the deportment of girls was significantly disrupted. (Author/SJL)

Save the World on Your Own Time

ERIC Educational Resources Information Center

Fish, Stanley

2008-01-01

What should be the role of our institutions of higher education? To promote good moral character? To bring an end to racism, sexism, economic oppression, and other social ills? To foster diversity and democracy and produce responsible citizens? In "Save the World On Your Own Time", Stanley Fish argues that, however laudable these goals might be,…

76 FR 71437 - Mutual Savings Association Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-17

... the public interest in order for the OCC to study the needs of and challenges facing mutual savings... for their time, but are eligible for reimbursement of travel expenses in accordance with applicable...

77 FR 48552 - Meetings of Humanities Panel

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-14

... room numbers. FOR FURTHER INFORMATION CONTACT: Lisette Voyatzis, Committee Management Officer, 1100...: September 6, 2012. Time: 8:30 a.m. to 5:00 p.m. Room: 415. This meeting will discuss applications for the... Access. 2. Date: September 6, 2012. Time: 8:30 a.m. to 5:00 p.m. Room: 421. This meeting will discuss...

Swedish District Nurses' experiences on the use of information and communication technology for supporting people with serious chronic illness living at home--a case study.

PubMed

Nilsson, Carina; Skär, Lisa; Söderberg, Siv

2010-06-01

The aim of this case study was to describe two District Nurses' (DN) experiences of using information and communication technology (ICT) to communicate with chronically ill people in their homes. An electronic messaging program via computers and mobile phones with an Internet connection was used, enabling DNs and the ill people to exchange messages to and from anywhere. The program comprised different virtual rooms, and communication was via text messages. The DNs in this study used the program two to four times each week from November 2003 to March 2004. Semi-structured interviews were performed before, during and after the implementation of the new technology and were analysed using thematic content analysis. The results showed that the DNs felt that the technology increased accessibility to nursing care through a more direct communication with the ill person meaning that a more trusting relationship could be created. The DNs also experienced that the use of ICT saved working time. This study indicates that the use of ICT for communication allowed the DN to better support a chronically ill person at home leading to improved home nursing care. This method of communication cannot replace physical presence, but can be seen as a complement to nursing care at home.

12 CFR 170.4 - Issuance of orders to correct deficiencies and to take or refrain from taking other actions.

Code of Federal Regulations, 2013 CFR

2013-01-01

...) Notice of intent to issue order—(1) In general. The OCC shall provide a Federal savings association prior written notice of the OCC's intention to issue an order requiring the savings association to correct a... the FDI Act. The savings association shall have such time to respond to a proposed order as provided...

12 CFR 170.4 - Issuance of orders to correct deficiencies and to take or refrain from taking other actions.

Code of Federal Regulations, 2014 CFR

2014-01-01

...) Notice of intent to issue order—(1) In general. The OCC shall provide a Federal savings association prior written notice of the OCC's intention to issue an order requiring the savings association to correct a... the FDI Act. The savings association shall have such time to respond to a proposed order as provided...

12 CFR 170.4 - Issuance of orders to correct deficiencies and to take or refrain from taking other actions.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) Notice of intent to issue order—(1) In general. The OCC shall provide a Federal savings association prior written notice of the OCC's intention to issue an order requiring the savings association to correct a... the FDI Act. The savings association shall have such time to respond to a proposed order as provided...

Social Security and Saving: A Time-Series Econometrics Pedagogical Example (With "R" Code)

ERIC Educational Resources Information Center

Wassell, Charles S., Jr.

2018-01-01

In 1974, and then again in 1996, Martin Feldstein published studies of the impact of the Social Security system on private saving in the U.S. economy. He found that Social Security depressed personal saving by a substantial amount--up to 50 percent. The author uses the Feldstein data and empirical models in this article to illustrate the steps in…

Effect of savings-led economic empowerment on HIV preventive practices among orphaned adolescents in rural Uganda: results from the Suubi-Maka randomized experiment

PubMed Central

Jennings, Larissa; Ssewamala, Fred M.; Nabunya, Proscovia

2015-01-01

Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents’ cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10–17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US12.32, ±1.12, p < .001) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group (p < .001). The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home (ΔT1−T0 = +14.9, p < .001), pursue vocational training (ΔT1−T0 = +8.8, p < .01), and start a business (T1−T0 = +6.7, p < .01). Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores (b = +0.19, ±0.09, p < .05), most commonly toward perceived risk of HIV (95.8%, n = 159), sexual abstinence or postponement (91.6%, n = 152), and consistent condom use (93.4%, n = 144). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score (OR = 2.017, 95%CI: 1.43–2.84). To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions. PMID:26548549

Navigation API Route Fuel Saving Opportunity Assessment on Large-Scale Real-World Travel Data for Conventional Vehicles and Hybrid Electric Vehicles: Preprint

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

Zhu, Lei; Holden, Jacob; Gonder, Jeffrey D

The green routing strategy instructing a vehicle to select a fuel-efficient route benefits the current transportation system with fuel-saving opportunities. This paper introduces a navigation API route fuel-saving evaluation framework for estimating fuel advantages of alternative API routes based on large-scale, real-world travel data for conventional vehicles (CVs) and hybrid electric vehicles (HEVs). The navigation APIs, such Google Directions API, integrate traffic conditions and provide feasible alternative routes for origin-destination pairs. This paper develops two link-based fuel-consumption models stratified by link-level speed, road grade, and functional class (local/non-local), one for CVs and the other for HEVs. The link-based fuel-consumption modelsmore » are built by assigning travel from a large number of GPS driving traces to the links in TomTom MultiNet as the underlying road network layer and road grade data from a U.S. Geological Survey elevation data set. Fuel consumption on a link is calculated by the proposed fuel consumption model. This paper envisions two kinds of applications: 1) identifying alternate routes that save fuel, and 2) quantifying the potential fuel savings for large amounts of travel. An experiment based on a large-scale California Household Travel Survey GPS trajectory data set is conducted. The fuel consumption and savings of CVs and HEVs are investigated. At the same time, the trade-off between fuel saving and time saving for choosing different routes is also examined for both powertrains.« less

Real-time modeling of heat distributions

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

Hamann, Hendrik F.; Li, Hongfei; Yarlanki, Srinivas

Techniques for real-time modeling temperature distributions based on streaming sensor data are provided. In one aspect, a method for creating a three-dimensional temperature distribution model for a room having a floor and a ceiling is provided. The method includes the following steps. A ceiling temperature distribution in the room is determined. A floor temperature distribution in the room is determined. An interpolation between the ceiling temperature distribution and the floor temperature distribution is used to obtain the three-dimensional temperature distribution model for the room.

CeHIO6·4H2O: A novel, highly efficient catalyst for degrading organic dyes without light illumination at room temperature

NASA Astrophysics Data System (ADS)

Ma, Xinping; Li, Jiayin; Liu, Haoran; Tang, Jianting

2018-07-01

It is still desirable to obtain the catalysts to degrade organic dye pollutants at room temperature, which meets the current demands of pollutant-removing and energy-saving simultaneously. By a facile precipitation method, we prepared in this work a new, highly efficient CeHIO6·4H2O catalyst. By characterization, it was found that the CeHIO6·4H2O sample is in nature a yellow inorganic semiconductor with particle size of 0.2-10 μm, band gap of 2.75 eV, low surface area of 1.52 m2 g-1 and amorphous structure. The CeHIO6·4H2O catalyst showed high activity in degradation of rhodamine B (RhB), methyl orange (MO) and methylene blue (MB) in the dark at room temperature. After being used for 3 cycles, it did not undergo significant loss of activity and kept its chemical composition unchanged in the degradation experiments. More importantly, its activity is remarkably higher than that of the previously reported Ce(IO3)4, CeGeO4, ZrHIO6·4H2O and Ce-doped MoO3 analogues. The major active species and the catalytic mechanism for the dye degradation were proposed.

How to Create a Personal Health Record

MedlinePlus

... learned that a PHR saves time, energy, and money. And it saved my life! A woman's Facebook ... Doctor’s Visit A Reference Guide Blue Button Resources Mobile PHRs Blog FAQ © 2018 AHIMA, All Rights Reserved | ...

A properly adjusted forage harvester can save time and money

USDA-ARS?s Scientific Manuscript database

A properly adjusted forage harvester can save fuel and increase the realizable milk per ton of your silage. This article details the adjustments necessary to minimize energy while maximizing productivity and forage quality....

31 CFR 360.12 - Disposition of excess.

Code of Federal Regulations, 2010 CFR

2010-07-01

... STATES SAVINGS BONDS, SERIES I Limitations on Annual Purchases § 360.12 Disposition of excess. If any person at any time has savings bonds issued during any one calendar year in excess of the prescribed...

31 CFR 360.12 - Disposition of excess.

Code of Federal Regulations, 2014 CFR

2014-07-01

... STATES SAVINGS BONDS, SERIES I Limitations on Annual Purchases § 360.12 Disposition of excess. If any person at any time has savings bonds issued during any one calendar year in excess of the prescribed...

31 CFR 353.12 - Disposition of excess.

Code of Federal Regulations, 2013 CFR

2013-07-01

... STATES SAVINGS BONDS, SERIES EE AND HH Limitations on Annual Purchases § 353.12 Disposition of excess. If any person at any time has savings bonds issued during any one calendar year in excess of the...

31 CFR 353.12 - Disposition of excess.

Code of Federal Regulations, 2014 CFR

2014-07-01

... STATES SAVINGS BONDS, SERIES EE AND HH Limitations on Annual Purchases § 353.12 Disposition of excess. If any person at any time has savings bonds issued during any one calendar year in excess of the...

31 CFR 353.12 - Disposition of excess.

Code of Federal Regulations, 2010 CFR

2010-07-01

... STATES SAVINGS BONDS, SERIES EE AND HH Limitations on Annual Purchases § 353.12 Disposition of excess. If any person at any time has savings bonds issued during any one calendar year in excess of the...

31 CFR 360.12 - Disposition of excess.

Code of Federal Regulations, 2013 CFR

2013-07-01

... STATES SAVINGS BONDS, SERIES I Limitations on Annual Purchases § 360.12 Disposition of excess. If any person at any time has savings bonds issued during any one calendar year in excess of the prescribed...

Creating Engaging Escape Rooms for the Classroom

ERIC Educational Resources Information Center

Nicholson, Scott

2018-01-01

Escape rooms are "live-action team-based games where players discover clues, solve puzzles, and accomplish tasks in one or more rooms in order to accomplish a specific goal (usually escaping from the room) in a limited amount of time." Escape Rooms are one type of Escape Game, which are narrative-based challenges that use puzzles, tasks,…

9 CFR 354.241 - Cleaning of rooms and compartments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... compartments. Rooms, compartments, or other parts of the official plant shall be kept clean and in sanitary... light fixtures in the official plant shall be kept clean. (c) All docks and rooms shall be kept clean... rooms should be kept clean at all times. (e) Floors in live rabbit holding rooms shall be cleaned with...

9 CFR 354.241 - Cleaning of rooms and compartments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... compartments. Rooms, compartments, or other parts of the official plant shall be kept clean and in sanitary... light fixtures in the official plant shall be kept clean. (c) All docks and rooms shall be kept clean... rooms should be kept clean at all times. (e) Floors in live rabbit holding rooms shall be cleaned with...

Estimating the Energy, Demand and Cost Savings from a Geothermal Heat Pump ESPC Project at Fort Polk, LA Through Utility Bill Analysis.

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

Shonder, John A; Hughes, Patrick

2006-01-01

Energy savings performance contracts (ESPCs) are a method of financing energy conservation projects using the energy cost savings generated by the conservation measures themselves. Ideally, reduced energy costs are visible as reduced utility bills, but in fact this is not always the case. On large military bases, for example, a single electric meter typically covers hundreds of individual buildings. Savings from an ESPC involving only a small number of these buildings will have little effect on the overall utility bill. In fact, changes in mission, occupancy, and energy prices could cause substantial increases in utility bills. For this reason, other,more » more practical, methods have been developed to measure and verify savings in ESPC projects. Nevertheless, increasing utility bills--when ESPCs are expected to be reducing them--are problematic and can lead some observers to question whether savings are actually being achieved. In this paper, the authors use utility bill analysis to determine energy, demand, and cost savings from an ESPC project that installed geothermal heat pumps in the family housing areas of the military base at Fort Polk, Louisiana. The savings estimates for the first year after the retrofits were found to be in substantial agreement with previous estimates that were based on submetered data. However, the utility bills also show that electrical use tended to increase as time went on. Since other data show that the energy use in family housing has remained about the same over the period, the authors conclude that the savings from the ESPC have persisted, and increases in electrical use must be due to loads unassociated with family housing. This shows that under certain circumstances, and with the proper analysis, utility bills can be used to estimate savings from ESPC projects. However, these circumstances are rare and over time the comparison may be invalidated by increases in energy use in areas unaffected by the ESPC.« less

Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation†

PubMed Central

Paton, F.; Paulden, M.; Chambers, D.; Heirs, M.; Duffy, S.; Hunter, J. M.; Sculpher, M.; Woolacott, N.

2010-01-01

Summary The cost-effectiveness of sugammadex for the routine reversal of muscle relaxation produced by rocuronium or vecuronium in UK practice is uncertain. We performed a systematic review of randomized controlled trials of sugammadex compared with neostigmine/glycopyrrolate and an economic assessment of sugammadex for the reversal of moderate or profound neuromuscular block (NMB) produced by rocuronium or vecuronium. The economic assessment aimed to establish the reduction in recovery time and the ‘value of time saved’ which would be necessary for sugammadex to be potentially cost-effective compared with existing practice. Three trials indicated that sugammadex 2 mg kg−1 (4 mg kg−1) produces more rapid recovery from moderate (profound) NMB than neostigmine/glycopyrrolate. The economic assessment indicated that if the reductions in recovery time associated with sugammadex in the trials are replicated in routine practice, sugammadex would be cost-effective if those reductions are achieved in the operating theatre (assumed value of staff time, £4.44 per minute), but not if they are achieved in the recovery room (assumed value of staff time, £0.33 per minute). However, there is considerable uncertainty in these results. Sugammadex has the potential to be cost-effective compared with neostigmine/glycopyrrolate for the reversal of rocuronium-induced moderate or profound NMB, provided that the time savings observed in trials can be achieved and put to productive use in clinical practice. Further research is required to evaluate the effects of sugammadex on patient safety, predictability of recovery from NMB, patient outcomes, and efficient use of resources. PMID:20935005

[Leipzig fast-track protocol for cardio-anesthesia. Effective, safe and economical].

PubMed

Häntschel, D; Fassl, J; Scholz, M; Sommer, M; Funkat, A K; Wittmann, M; Ender, J

2009-04-01

In November 2005 a complex, multimodal anesthesia fast-track protocol (FTP) was introduced for elective cardiac surgery patients in the Cardiac Center of the University of Leipzig which included changing from an opioid regime to remifentanil and postoperative treatment in a special post-anesthesia recovery and care unit. The goal was to speed up recovery times while maintaining safety and improving costs. A total of 421 patients who underwent the FTP and were treated in the special recovery room were analyzed retrospectively. These patients were compared with patients who had been treated by a standard protocol (SP) prior to instituting the FTP. Primary outcomes were time to extubation, length of stay in the intensive care unit (ICU) and treatment costs. The times to extubation were significantly shorter in the FTP group with 75 min (range 45-110 min) compared to 900 min (range 600-1140 min) in the SP group. Intensive care unit stay and hospital length of stay were also significantly shorter in the FTP group (p<0.01). The reduction of treatment costs of intensive care for FTP patients was 53.5% corresponding to savings of EUR 738 per patient in the FTP group compared with the SP group. The Leipzig fast-track protocol for cardio-anesthesia including the central elements of switching opiate therapy to remifentanil and switching patient recovery to a special post-anesthesia recovery and care unit, shortened therapy times, is safe and economically effective.

Acute hospital costs after minimally invasive versus open lumbar interbody fusion: data from a US national database with 6106 patients.

PubMed

Wang, Michael Y; Lerner, Jason; Lesko, James; McGirt, Matthew J

2012-08-01

Retrospective multi-institutional database review. To determine if minimally invasive interbody fusion is associated with cost savings when compared with open surgery. Minimally invasive spine (MIS) surgeries are increasingly recognized as equivalent to open procedures. Although these techniques have been advocated for reducing pain, disability, and length of hospitalization, to date there has been little data demonstrating these benefits. This study analyzed inpatient hospital records from the Premier Perspective database (2002 to 2009), including patients who underwent a posterior lumbar fusion with interbody cage placement by ICD-9 code, and had implant charge codes that allowed determination if MIS pedicle screws were utilized. Exclusion criteria included a refusion surgery, deformity, >2 levels, and anterior fusion. Total costs were adjusted for covariates (age, sex, race, hospital geography and setting, payor, and comorbidities) using an analysis of covariance model. A total of 6106 patients were identified (1667 MIS and 4439 open). Length of stay (LOS) for 1-level MIS surgery averaged of 3.35 days versus 3.6 days for open surgery (P≤0.006). For 2-level MIS surgery LOS averaged of 3.4 days versus 4.03 days for open surgery (P≤0.001). Total inflation-adjusted acute hospitalization cost averaged $29,187 for 1-level MIS procedures versus $29,947 for open surgery, a nonsignificant difference (P=0.55). Total inflation-adjusted acute hospitalization cost averaged $2106 lower for 2-level MIS surgery (total costs of $33,879 for MIS vs. $35,984 for open surgery, P=0.0023). Cost savings were attributable primarily to lower room and board ($857), operating room ($359), pharmacy ($304), and laboratory ($166) costs in the MIS group. High variances in the 2-level open surgery with prolonged hospital stay also accounted for overall cost differences. This data from a large nationwide sample of hospitalizations demonstrates that MIS lumbar interbody fusion results in a statistically significant reduction in hospital LOS and a reduction in total hospital costs with 2-level surgery after adjusting for significant covariates. The majority of cost savings from MIS surgery were due to more rapid mobilization and discharge, as well as a reduction in outliers with extended hospitalizations.

Architectural Analysis of Complex Evolving Systems of Systems

NASA Technical Reports Server (NTRS)

Lindvall, Mikael; Stratton, William C.; Sibol, Deane E.; Ray, Arnab; Ackemann, Chris; Yonkwa, Lyly; Ganesan, Dharma

2009-01-01

The goal of this collaborative project between FC-MD, APL, and GSFC and supported by NASA IV&V Software Assurance Research Program (SARP), was to develop a tool, Dynamic SAVE, or Dyn-SAVE for short, for analyzing architectures of systems of systems. The project team was comprised of the principal investigator (PI) from FC-MD and four other FC-MD scientists (part time) and several FC-MD students (full time), as well as, two APL software architects (part time), and one NASA POC (part time). The PI and FC-MD scientists together with APL architects were responsible for requirements analysis, and for applying and evaluating the Dyn-SAVE tool and method. The PI and a group of FC-MD scientists were responsible for improving the method and conducting outreach activities, while another group of FC-MD scientists were responsible for development and improvement of the tool. Oversight and reporting was conducted by the PI and NASA POC. The project team produced many results including several prototypes of the Dyn-SAVE tool and method, several case studies documenting how the tool and method was applied to APL s software systems, and several published papers in highly respected conferences and journals. Dyn-SAVE as developed and enhanced throughout this research period, is a software tool intended for software developers and architects, software integration testers, and persons who need to analyze software systems from the point of view of how it communicates with other systems. Using the tool, the user specifies the planned communication behavior of the system modeled as a sequence diagram. The user then captures and imports the actual communication behavior of the system, which is then converted and visualized as a sequence diagram by Dyn-SAVE. After mapping the planned to the actual and specifying parameter and timing constraints, Dyn-SAVE detects and highlights deviations between the planned and the actual behavior. Requirements based on the need to analyze two inter-system communication protocols that are representative of protocols used in the Aerospace industry have been specified. The protocols are related: APL s Common Ground System (CGS) as used in the MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) and the Radiation Belt Space Probes (RBSP) missions. The analyzed communications were implementations of the Telemetry protocol and the CCSDS File Delivery Protocol (CFDP) protocol. Based on these requirements, three prototypes of Dyn-SAVE were developed and applied to these protocols. The application of Dyn-SAVE to these protocols resulted in the detection of several issues. Dyn-SAVE was also applied to several Testbeds that have previously been used for experimentation earlier on this project, as well as, to other protocols and logs for testing its broader applicability. For example, Dyn-SAVE was used to analyze 1) the communication pattern between a web browser and a web server, 2) the system log of a computer in order to detect offnominal computer shut-down behavior, and 3) the actual test cases of NASA Goddard s Core Flight System (CFS) and automatically generated test cases in order to determine the overlap between the two sets of test cases. In all cases, Dyn-SAVE assisted in providing insightful conclusions about each of the cases identified above.

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

Steffen, Jason H.; Hotchkiss, Jon

We report the results of an experimental comparison of different airplane boarding methods. This test was conducted in a mock 757 fuselage, located on a Southern California soundstage, with 12 rows of six seats and a single aisle. Five methods were tested using 72 passengers of various ages. We found a significant reduction in the boarding times of optimized methods over traditional methods. These improved methods, if properly implemented, could result in a significant savings to airline companies. The process of boarding an airplane is of interest to a variety of groups. The public is interested both as a curiosity,more » as it is something that they may regularly experience, and as a consumer, as their experiences good or bad can affect their loyalties. Airline companies and their employees also have a stake in an efficient boarding procedure as time saved in the boarding process may result is monetary savings, in the quality of interactions with passengers, and in the application of human resources to the general process of preparing an airplane for departure. A recent study (Nyquist and McFadden, 2008) indicates that the average cost to an airline company for each minute of time spent at the terminal is roughly $30. Thus, each minute saved in the turn-around time of a flight has the potential to generate over $16,000,000 in annual savings (assuming an average of 1500 flights per day). While the boarding process may not be the primary source of delay in returning an airplane to the skies, reducing the boarding time may effectively eliminate passenger boarding as a contributor in any meaningful measure. Consequently, subsequent efforts to streamline the other necessary tasks, such as refueling and maintenance, would be rewarded with a material reduction in time at the gate for each flight.« less

Experimental test of airplane boarding methods

DOE PAGES

Steffen, Jason H.; Hotchkiss, Jon

2011-10-26

We report the results of an experimental comparison of different airplane boarding methods. This test was conducted in a mock 757 fuselage, located on a Southern California soundstage, with 12 rows of six seats and a single aisle. Five methods were tested using 72 passengers of various ages. We found a significant reduction in the boarding times of optimized methods over traditional methods. These improved methods, if properly implemented, could result in a significant savings to airline companies. The process of boarding an airplane is of interest to a variety of groups. The public is interested both as a curiosity,more » as it is something that they may regularly experience, and as a consumer, as their experiences good or bad can affect their loyalties. Airline companies and their employees also have a stake in an efficient boarding procedure as time saved in the boarding process may result is monetary savings, in the quality of interactions with passengers, and in the application of human resources to the general process of preparing an airplane for departure. A recent study (Nyquist and McFadden, 2008) indicates that the average cost to an airline company for each minute of time spent at the terminal is roughly $30. Thus, each minute saved in the turn-around time of a flight has the potential to generate over $16,000,000 in annual savings (assuming an average of 1500 flights per day). While the boarding process may not be the primary source of delay in returning an airplane to the skies, reducing the boarding time may effectively eliminate passenger boarding as a contributor in any meaningful measure. Consequently, subsequent efforts to streamline the other necessary tasks, such as refueling and maintenance, would be rewarded with a material reduction in time at the gate for each flight.« less

Initial laparoscopic basic skills training shortens the learning curve of laparoscopic suturing and is cost-effective.

PubMed

Stefanidis, Dimitrios; Hope, William W; Korndorffer, James R; Markley, Sarah; Scott, Daniel J

2010-04-01

Laparoscopic suturing is an advanced skill that is difficult to acquire. Simulator-based skills curricula have been developed that have been shown to transfer to the operating room. Currently available skills curricula need to be optimized. We hypothesized that mastering basic laparoscopic skills first would shorten the learning curve of a more complex laparoscopic task and reduce resource requirements for the Fundamentals of Laparoscopic Surgery suturing curriculum. Medical students (n = 20) with no previous simulator experience were enrolled in an IRB-approved protocol, pretested on the Fundamentals of Laparoscopic Surgery suturing model, and randomized into 2 groups. Group I (n = 10) trained (unsupervised) until proficiency levels were achieved on 5 basic tasks; Group II (n = 10) received no basic training. Both groups then trained (supervised) on the Fundamentals of Laparoscopic Surgery suturing model until previously reported proficiency levels were achieved. Two weeks later, they were retested to evaluate their retention scores, training parameters, instruction requirements, and cost between groups using t-test. Baseline characteristics and performance were similar for both groups, and 9 of 10 subjects in each group achieved the proficiency levels. The initial performance on the simulator was better for Group I after basic skills training, and their suturing learning curve was shorter compared with Group II. In addition, Group I required less active instruction. Overall time required to finish the curriculum was similar for both groups; but the Group I training strategy cost less, with a savings of $148 per trainee. Teaching novices basic laparoscopic skills before a more complex laparoscopic task produces substantial cost savings. Additional studies are needed to assess the impact of such integrated curricula on ultimate educational benefit. Copyright (c) 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Replacement of Expensive, Disposable Instruments With Old-fashioned Surgical Techniques for Improved Cost-effectiveness in Laparoscopic Hysterectomy

PubMed Central

Morrison, John E.

2004-01-01

Objective: Patients demand that health care and procedures in rural areas be provided by ambulatory surgery centers close to home. However, the reimbursement rate for such procedures in ambulatory centers is extremely low, so a standard classic intrafascial supracervical hysterectomy procedure needs to be more cost effective to be performed there. Instruments and disposable devices can make up ≥50% of hospital costs for this procedure, so any cost reduction has to focus on this aspect. Methods: We identified the 3 most expensive disposable devices: (1) an Endostapler, US $498 and 3 staple reloads, US $179 each; (2) a calibrated uterine resection tool 15 mm for encoring of the endocervical canal, US $853; and (3) a serrated edged macro morcellator for intraabdominal uterus morcellation, US $321, and substituted them using classic conservative surgical techniques. Results: From September 2001 to September 2002, we performed 26 procedures with this modified technique at an ambulatory surgery center with a follow-up of 6.7 (2 to 14) months. This modified operative technique was feasible; no conversions were necessary, and no complications occurred. Cost savings were US $2209 per procedure; additional costs were US $266.33 for suture material and an Endopouch, resulting in an overall savings of US $50 509.42. The disadvantage was an increase in operating room time of about 1 hour 20 minutes per case. Conclusion: These modifications in the classic intrafascial supracervical hysterectomy technique have proven to be feasible, safe, and highly cost effective, especially for a rural ambulatory surgery center. Long-term follow-up is necessary to further evaluate these operative modifications. PMID:15119671

Chinese hotel general managers' perspectives on energy-saving practices

NASA Astrophysics Data System (ADS)

Zhu, Yidan

As hotels' concern about sustainability and budget-control is growing steadily, energy-saving issues have become one of the important management concerns hospitality industry face. By executing proper energy-saving practices, previous scholars believed that hotel operation costs can decrease dramatically. Moreover, they believed that conducting energy-saving practices may eventually help the hotel to gain other benefits such as an improved reputation and stronger competitive advantage. The energy-saving issue also has become a critical management problem for the hotel industry in China. Previous research has not investigated energy-saving in China's hotel segment. To achieve a better understanding of the importance of energy-saving, this document attempts to present some insights into China's energy-saving practices in the tourist accommodations sector. Results of the study show the Chinese general managers' attitudes toward energy-saving issues and the differences among the diverse hotel managers who responded to the study. Study results indicate that in China, most of the hotels' energy bills decrease due to the implementation of energy-saving equipments. General managers of hotels in operation for a shorter period of time are typically responsible for making decisions about energy-saving issues; older hotels are used to choosing corporate level concerning to this issue. Larger Chinese hotels generally have official energy-saving usage training sessions for employees, but smaller Chinese hotels sometimes overlook the importance of employee training. The study also found that for the Chinese hospitality industry, energy-saving practices related to electricity are the most efficient and common way to save energy, but older hotels also should pay attention to other ways of saving energy such as water conservation or heating/cooling system.

Urban Telemedicine: The Applicability of Teleburns in the Rehabilitative Phase.

PubMed

Liu, Yuk Ming; Mathews, Katie; Vardanian, Andrew; Bozkurt, Taylan; Schneider, Jeffrey C; Hefner, Jaye; Schulz, John T; Fagan, Shawn P; Goverman, Jeremy

Telemedicine has been successfully used in many areas of medicine, including triage and evaluation of the acute burn patient. The utility of telemedicine during the rehabilitative phase of burn care has yet to be evaluated; therefore, we expanded our telemedicine program to link our burn center with a rehabilitation facility. The goal of this project was to demonstrate cost-effective improvements in the transition and quality of care. A retrospective review was performed on all patients enrolled in our telemedicine/rehabilitation program between March 2013 and March 2014. Data collected included total number of encounters, visits, type of visit, physician time, and readmissions. Transportation costs were based on local ambulance rates between the two facilities. The impact of telemedicine was evaluated with respect to the time saved for the physician, burn center, and burn clinic, as well as rehabilitative days saved. A patient satisfaction survey was also administered. A total of 29 patients participated in 73 virtual visits through the telemedicine project. Virtual visits included new consults, preoperative evaluations, and postoperative follow-ups. A total of 146 ambulance transports were averted during the study period, totaling $101,110. Virtual visits saved 6.8 outpatient burn clinic days, or 73 clinic appointments of 30-min duration. The ability to perform more outpatient surgery resulted in 80 inpatient bed days saved at the burn hospital. The rehabilitation hospital saved an average of 2 to 3 patient days secondary to unnecessary travel. Satisfaction surveys demonstrated patient satisfaction with the encounters, primarily related to time saved. The decrease in travel time for the patient from the rehabilitation hospital to outpatient burn clinic improved adherence to the rehabilitation care plan and resulted in increased throughput at the rehabilitation facility. Videoconferencing between a burn center and rehabilitation hospital streamlined patient care and reduced health care costs, while maintaining quality of care and patient satisfaction. This program has improved inpatient burn rehabilitation by maximizing time spent in therapy and avoiding unnecessary patient travel to offsite appointments.

[Global MED-NET].

PubMed

Slatina, E

2000-01-01

This poster will show a concept as well as some practical solutions for the database which is intended to be used by all members and institutions of the Emergency Medical Care international institutions network. This poster shows how data is automatically processed in a rapid and good quality way, while in the same time the lives are saved and time and money are saved too.

Assessing Your Assets: Systems for Tracking and Managing IT Assets Can Save Time and Dollars

ERIC Educational Resources Information Center

Holub, Patricia A.

2007-01-01

The average school district loses more than $80,000 per year because of lost or damaged IT assets, according to a QED survey cosponsored by Follett Software Company. And many districts--59 percent--still use manual systems to track assets. Enter asset management systems. Software for managing assets, when implemented properly, can save time,…

31 CFR 315.35 - Payment (redemption).

Code of Federal Regulations, 2014 CFR

2014-07-01

... and Savings Notes. A Series E bond will be paid at any time after two months from issue date at the... time after six (6) months from issue date. In any case where Series H bonds are surrendered to a..., SERIES A, B, C, D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES General Provisions for Payment § 315.35...

Implementation and evaluation of an automated dispensing system.

PubMed

Schwarz, H O; Brodowy, B A

1995-04-15

An institution's experience in replacing a traditional unit dose cassette-exchange system with an automated dispensing system is described. A 24-hour unit dose cassette-exchange system was replaced with an automated dispensing system (Pyxis's Medstation Rx) on a 36-bed cardiovascular surgery unit and an 8-bed cardiovascular intensive care unit. Significantly fewer missing doses were reported after Medstation Rx was implemented. No conclusions could be made about the impact of the system on the reporting of medication errors. The time savings for pharmacy associated with the filling, checking, and delivery of new medication orders equated to about 0.5 full-time equivalent (FTE). Medstation Rx also saved substantial nursing time for acquisition of controlled substances and for controlled-substance inventory taking at shift changes. A financial analysis showed that Medstation Rx could save the institution about $1 million over five years if all personnel time savings could be translated into FTE reductions. The automated system was given high marks by the nurses in a survey; 80% wanted to keep the system on their unit. Pilot implementation of an automated dispensing system improved the efficiency of drug distribution over that of the traditional unit dose cassette-exchange system.

Multi-User Low Intrusive Occupancy Detection

PubMed Central

Widyawan, Widyawan; Lazovik, Alexander

2018-01-01

Smart spaces are those that are aware of their state and can act accordingly. Among the central elements of such a state is the presence of humans and their number. For a smart office building, such information can be used for saving energy and safety purposes. While acquiring presence information is crucial, using sensing techniques that are highly intrusive, such as cameras, is often not acceptable for the building occupants. In this paper, we illustrate a proposal for occupancy detection which is low intrusive; it is based on equipment typically available in modern offices such as room-level power-metering and an app running on workers’ mobile phones. For power metering, we collect the aggregated power consumption and disaggregate the load of each device. For the mobile phone, we use the Received Signal Strength (RSS) of BLE (Bluetooth Low Energy) nodes deployed around workspaces to localize the phone in a room. We test the system in our offices. The experiments show that sensor fusion of the two sensing modalities gives 87–90% accuracy, demonstrating the effectiveness of the proposed approach. PMID:29509693

Cost-Benefit of Improving the Efficiency of Room Air Conditioners (Inverter and Fixed Speed) in India

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

Phadke, Amol; Shah, Nihar; Abhyankar, Nikit

Improving efficiency of air conditioners (ACs) typically involves improving the efficiency of various components such as compressors, heat exchangers, expansion valves, refrigerant,and fans. We estimate the incremental cost of improving the efficiency of room ACs based on the cost of improving the efficiency of its key components. Further, we estimate the retail price increase required to cover the cost of efficiency improvement, compare it with electricity bill savings, and calculate the payback period for consumers to recover the additional price of a more efficient AC. The finding that significant efficiency improvement is cost effective from a consumer perspective is robustmore » over a wide range of assumptions. If we assume a 50% higher incremental price compared to our baseline estimate, the payback period for the efficiency level of 3.5 ISEER is 1.1 years. Given the findings of this study, establishing more stringent minimum efficiency performance criteria (one-star level) should be evaluated rigorously considering significant benefits to consumers, energy security, and environment« less

Hyperbaric storage of melon juice at and above room temperature and comparison with storage at atmospheric pressure and refrigeration.

PubMed

Queirós, Rui P; Santos, Mauro D; Fidalgo, Liliana G; Mota, Maria J; Lopes, Rita P; Inácio, Rita S; Delgadillo, Ivonne; Saraiva, Jorge A

2014-03-15

Hyperbaric storage (8h) of melon juice (a highly perishable food) at 25, 30 and 37°C, under pressure at 25-150 MPa was compared with atmospheric pressure storage (0.1 MPa) at the same temperatures and under refrigeration (4°C). Comparatively to the refrigerated condition, hyperbaric storage at 50/75 MPa resulted in similar or lower microbial counts (total aerobic mesophiles, enterobacteriaceae, and yeasts/moulds) while at 100/150 MPa, the counts were lower for all the tested temperatures, indicating in the latter case, in addition to microbial growth inhibition, a microbial inactivation effect. At 25 MPa no microbial inhibition was observed. Physicochemical parameters of all samples stored under pressure (pH, titratable acidity, total soluble solids, browning degree and cloudiness) did not show a clear variation trend with pressure, being the results globally similar to refrigeration storage. These results show the potential of hyperbaric storage, at and above room temperature and with potential energy savings, comparatively to refrigeration. Copyright © 2013 Elsevier Ltd. All rights reserved.

Validation of an endothelial roll preparation for Descemet Membrane Endothelial Keratoplasty by a cornea bank using "no touch" dissection technique.

PubMed

Marty, Anne-Sophie; Burillon, Carole; Desanlis, Adeline; Damour, Odile; Kocaba, Viridiana; Auxenfans, Céline

2016-06-01

Descemet Membrane Endothelial Keratoplasty (DMEK) selectively replaces the damaged posterior part of the cornea. However, the DMEK technique relies on a manually-performed dissection that is time-consuming, requires training and presents a potential risk of endothelial graft damages leading to surgery postponement when performed by surgeons in the operative room. To validate precut corneal tissue preparation for DMEK provided by a cornea bank in order to supply a quality and security precut endothelial tissue. The protocol was a technology transfer from the Netherlands Institute for Innovative Ocular Surgery (NIIOS) to Lyon Cornea Bank, after formation in NIIOS to the DMEK "no touch" dissection technique. The technique has been validated in selected conditions (materials, microscope) and after a learning curve, cornea bank technicians prepared endothelial tissue for DMEK. Endothelial cells densities (ECD) were evaluated before and after preparation, after storage and transport to the surgery room. Microbiological and histological controls have been done. Twenty corneas were manually dissected; 18 without tears. Nineteen endothelial grafts formed a double roll. The ECD loss after cutting was 3.3 % (n = 19). After transportation 7 days later, we found an ECD loss of 25 % (n = 12). Three days after cutting and transportation, we found 2.1 % of ECD loss (n = 7). Histology found an endothelial cells monolayer lying on Descemet membrane. The mean thickness was 12 ± 2.2 µm (n = 4). No microbial contamination was found (n = 19). Endothelial roll stability has been validated at 3 days in our cornea bank. Cornea bank technicians trained can deliver to surgeons an ECD controlled, safety and ready to use endothelial tissue, for DMEK by "no touch" technique, allowing time saving, quality and security for surgeons.

Community Savings Groups, Financial Security, and HIV Risk Among Female Sex Workers in Iringa, Tanzania.

PubMed

Mantsios, Andrea; Galai, Noya; Mbwambo, Jessie; Likindikoki, Samuel; Shembilu, Catherine; Mwampashi, Ard; Beckham, S W; Leddy, Anna; Davis, Wendy; Sherman, Susan; Kennedy, Caitlin; Kerrigan, Deanna

2018-02-24

This study assessed the association between community savings group participation and consistent condom use (CCU) among female sex workers (FSW) in Iringa, Tanzania. Using cross-sectional data from a survey of venue-based FSW (n = 496), logistic regression was used to examine the associations between financial indicators including community savings group participation and CCU. Over one-third (35%) of the women participated in a savings group. Multivariable regression results indicated that participating in a savings group was significantly associated with nearly two times greater odds of CCU with new clients in the last 30 days (aOR = 1.77, 95% CI 1.10-2.86). Exploratory mediation analysis indicated that the relationship between savings group participation and CCU was partially mediated by financial security, as measured by monthly income. Findings indicate that community savings groups may play an important role in reducing sexual risk behaviors of FSW and hold promise as part of comprehensive, community-led HIV prevention strategies among FSW.

Energy Savings Performance Contract Energy Sales Agreement Toolkit

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

None

FEMP developed the Energy Savings Performance Contracting Energy Sales Agreement (ESPC ESA) Toolkit to provide federal agency contracting officers and other acquisition team members with information that will facilitate the timely execution of ESPC ESA projects.

Pan Am gets big savings at no cost

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

Tanz, D.

Pan American World Airways' contract with an energy management control systems distributor enabled the company's terminal and maintenance facilities at JFK airport in New York to shift from housekeeping to major savings without additional cost. Energy savings from a pneumatic control system were split almost equally between Pan Am and Thomas S. Brown Associates (TSBA) Inc., and further savings are expected from a planned computer-controlled system. A full-time energy manager, able to give top priority to energy-consumption problems, was considered crucial to the program's success. Early efforts in light-level reduction and equipment scheduling required extensive persuasion and policing, but successfulmore » energy savings allowed the manager to progress to the more-extensive plants with TSBA.« less

On the economic growth theory with Kadiyala production function

NASA Astrophysics Data System (ADS)

Grassetti, Francesca; Hunanyan, Gevorg

2018-05-01

We study the discrete time neoclassical one-sector growth model with differential savings while assuming Kadiyala production function which shows a variable elasticity of substitution symmetric with respect to capital and labor. We show that, if workers save more than shareholders, then the growth path is bounded from above and the boundary is independent from the savings rate of shareholders. Moreover, the growth path for non-developed countries is influenced only by the savings rate of shareholders while level of capital per capita of developed economies is influenced by the savings rate of workers. We also show that multistability phenomena may occur so that the model is able to explain co-existence of under-developed, developing and developed economies. We prove that fluctuations and complex dynamics may arise when the elasticity of substitution between production factors is lower than one and shareholders save more than workers.

Reading and Television Viewing Habits of American Adults during Time Spent in Waiting Rooms.

ERIC Educational Resources Information Center

Spirn, Sharon L.

In order to determine the reading and television viewing habits of American adults during time spent in waiting rooms, a study observed 100 adults waiting outside the Emergency Treatment Room of John F. Kennedy Hospital in Edison, New Jersey, over a four-week period. Results revealed that more of these adults chose to watch television as an…

Saving Time, Saving Money: The Economics of Unclogging America's Worst Bottlenecks

DOT National Transportation Integrated Search

2000-01-01

A 1999 study by the American Highway Users Alliance entitled "Unclogging America's Arteries: Prescriptions for Healthier Highways" identified the 166 worst bottlenecks in the country and evaluated the benefits of removing them. By assigning monetary ...

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

PubMed

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

2011-07-01

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

A mathematical model of Clostridium difficile transmission in medical wards and a cost-effectiveness analysis comparing different strategies for laboratory diagnosis and patient isolation.

PubMed

Schechner, Vered; Carmeli, Yehuda; Leshno, Moshe

2017-01-01

Clostridium difficile infection (CDI) is a common and potentially fatal healthcare-associated infection. Improving diagnostic tests and infection control measures may prevent transmission. We aimed to determine, in resource-limited settings, whether it is more effective and cost-effective to allocate resources to isolation or to diagnostics. We constructed a mathematical model of CDI transmission based on hospital data (9 medical wards, 350 beds) between March 2010 and February 2013. The model consisted of three compartments: susceptible patients, asymptomatic carriers and CDI patients. We used our model results to perform a cost-effectiveness analysis, comparing four strategies that were different combinations of 2 test methods (the two-step test and uniform PCR) and 2 infection control measures (contact isolation in multiple-bed rooms or single-bed rooms/cohorting). For each strategy, we calculated the annual cost (of CDI diagnosis and isolation) for a decrease of 1 in the average daily number of CDI patients; the strategy of the two-step test and contact isolation in multiple-bed rooms was the reference strategy. Our model showed that the average number of CDI patients increased exponentially as the transmission rate increased. Improving diagnosis by adopting uniform PCR assay reduced the average number of CDI cases per day per 350 beds from 9.4 to 8.5, while improving isolation by using single-bed rooms reduced the number to about 1; the latter was cost saving. CDI can be decreased by better isolation and more sensitive laboratory methods. From the hospital perspective, improving isolation is more cost-effective than improving diagnostics.

A mathematical model of Clostridium difficile transmission in medical wards and a cost-effectiveness analysis comparing different strategies for laboratory diagnosis and patient isolation

PubMed Central

Carmeli, Yehuda; Leshno, Moshe

2017-01-01

Background Clostridium difficile infection (CDI) is a common and potentially fatal healthcare-associated infection. Improving diagnostic tests and infection control measures may prevent transmission. We aimed to determine, in resource-limited settings, whether it is more effective and cost-effective to allocate resources to isolation or to diagnostics. Methods We constructed a mathematical model of CDI transmission based on hospital data (9 medical wards, 350 beds) between March 2010 and February 2013. The model consisted of three compartments: susceptible patients, asymptomatic carriers and CDI patients. We used our model results to perform a cost-effectiveness analysis, comparing four strategies that were different combinations of 2 test methods (the two-step test and uniform PCR) and 2 infection control measures (contact isolation in multiple-bed rooms or single-bed rooms/cohorting). For each strategy, we calculated the annual cost (of CDI diagnosis and isolation) for a decrease of 1 in the average daily number of CDI patients; the strategy of the two-step test and contact isolation in multiple-bed rooms was the reference strategy. Results Our model showed that the average number of CDI patients increased exponentially as the transmission rate increased. Improving diagnosis by adopting uniform PCR assay reduced the average number of CDI cases per day per 350 beds from 9.4 to 8.5, while improving isolation by using single-bed rooms reduced the number to about 1; the latter was cost saving. Conclusions CDI can be decreased by better isolation and more sensitive laboratory methods. From the hospital perspective, improving isolation is more cost-effective than improving diagnostics. PMID:28187144

Minimizing lighting power density in office rooms equipped with Anidolic Daylighting Systems

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

Linhart, Friedrich; Scartezzini, Jean-Louis

2010-04-15

Electric lighting is responsible for up to one third of an office building's electricity needs. Making daylight more available in office buildings can not only contribute to significant energy savings but also enhance the occupants' performance and wellbeing. Anidolic Daylighting Systems (ADS) are one type of very effective facade-integrated daylighting systems. All south-facing office rooms within the LESO solar experimental building in Lausanne (Switzerland) are equipped with a given type of ADS. A recent study has shown that these offices' occupants are highly satisfied with their lighting environment. The most energy-efficient south-facing offices have a lighting power density of lessmore » than 5W/m{sup 2}. The lighting situation within these ''best practice''-offices has been assessed using the lighting simulation software RELUX Vision. Because this lighting situation is very much appreciated by the occupants, it was used as a starting point for developing even more energy-efficient office lighting designs. Two new lighting designs, leading to lighting power densities of 3.9W/m{sup 2} and 3W/m{sup 2}, respectively, have been suggested and simulated with RELUX Vision. Simulation results have shown that the expected performances of these new systems are comparable to that of the current lighting installation within the ''best practice''-offices or even better. These simulation results have been confirmed during experiments on 20 human subjects in a test office room recently set up within the LESO building. This article gives engineers, architects and light planers valuable information and ideas on how to design energy-efficient and comfortable electric lighting systems in office rooms with abundant access to daylight. (author)« less

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection.

PubMed

Basques, Bryce A; Golinvaux, Nicholas S; Bohl, Daniel D; Yacob, Alem; Toy, Jason O; Varthi, Arya G; Grauer, Jonathan N

2014-10-15

Retrospective database review. To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. The American College of Surgeons National Surgical Quality Improvement Program database, which includes data from more than 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without the use of an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. A total of 23,670 elective spine procedures were identified, of which 2226 (9.4%) used an operating microscope. The average patient age was 55.1±14.4 years. The average operative time (incision to closure) was 125.7±82.0 minutes.Microscope use was associated with minor increases in preoperative room time (+2.9 min, P=0.013), operative time (+13.2 min, P<0.001), and total room time (+18.6 min, P<0.001) on multivariate analysis.A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and nonmicroscope groups for occurrence of any infection, superficial surgical site infection, deep surgical site infection, organ space infection, or sepsis/septic shock, regardless of surgery type. We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. 3.

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection

PubMed Central

Basques, Bryce A.; Golinvaux, Nicholas S.; Bohl, Daniel D.; Yacob, Alem; Toy, Jason O.; Varthi, Arya G.; Grauer, Jonathan N.

2014-01-01

Study Design Retrospective database review. Objective To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Summary of Background Data Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which includes data from over 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. Results A total of 23,670 elective spine procedures were identified, of which 2,226 (9.4%) used an operating microscope. The average patient age was 55.1 ± 14.4 years. The average operative time (incision to closure) was 125.7 ± 82.0 minutes. Microscope use was associated with minor increases in preoperative room time (+2.9 minutes, p=0.013), operative time (+13.2 minutes, p<0.001), and total room time (+18.6 minutes, p<0.001) on multivariate analysis. A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and non-microscope groups for occurrence of any infection, superficial surgical site infection (SSI), deep SSI, organ space infection, or sepsis/septic shock, regardless of surgery type. Conclusions We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. PMID:25188600

The Impact of Patient-to-Patient Interaction in Health Facility Waiting Rooms on Their Perception of Health Professionals.

PubMed

Willis, William Kent; Ozturk, Ahmet Ozzie; Chandra, Ashish

2015-01-01

Patients have to wait in waiting rooms prior to seeing the physician. But there are few studies that demonstrate what they are actually doing in the waiting room. This exploratory study was designed to investigate the types of discussions that patients in the waiting room typically engage in with other patients and how the conversations affected their opinion on general reputation of the clinic, injections/blocks as treatment procedures, waiting time, time spent with the caregiver, overall patient satisfaction, and the pain medication usage policy. The study demonstrates that patient interaction in the waiting room has a positive effect on patient opinion of the pain clinic and the caregivers.

Building a Thriving Nation: 21st-Century Vision and Practice to Advance Health and Equity

ERIC Educational Resources Information Center

Cohen, Larry

2016-01-01

It is a great time for prevention. As the United States explores what health in our country should look like, it is an extraordinary time to highlight the role of prevention in improving health, saving lives, and saving money. The Affordable Care Act's investment in prevention has spurred innovation by communities and states to keep people healthy…

31 CFR 315.35 - Payment (redemption).

Code of Federal Regulations, 2013 CFR

2013-07-01

... and Savings Notes. A Series E bond will be paid at any time after two months from issue date at the... interest is $6.90 per $500. (e) Series H. A Series H bond will be redeemed at face value at any time after..., SERIES A, B, C, D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES General Provisions for Payment § 315.35...

31 CFR 315.35 - Payment (redemption).

Code of Federal Regulations, 2010 CFR

2010-07-01

... and Savings Notes. A Series E bond will be paid at any time after two months from issue date at the... interest is $6.90 per $500. (e) Series H. A Series H bond will be redeemed at face value at any time after..., SERIES A, B, C, D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES General Provisions for Payment § 315.35...

31 CFR 315.35 - Payment (redemption).

Code of Federal Regulations, 2012 CFR

2012-07-01

... and Savings Notes. A Series E bond will be paid at any time after two months from issue date at the... interest is $6.90 per $500. (e) Series H. A Series H bond will be redeemed at face value at any time after..., SERIES A, B, C, D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES General Provisions for Payment § 315.35...

31 CFR 315.35 - Payment (redemption).

Code of Federal Regulations, 2011 CFR

2011-07-01

... and Savings Notes. A Series E bond will be paid at any time after two months from issue date at the... interest is $6.90 per $500. (e) Series H. A Series H bond will be redeemed at face value at any time after..., SERIES A, B, C, D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES General Provisions for Payment § 315.35...

U.S. Navy Advanced Receiving: A Better Approach to the Basics.

DTIC Science & Technology

1987-04-01

the Navy and DLA should begin now to plan for electronic interchange of data between their inventory management systems. This would eliminate the...labor savings from work simplification, improved material handling, and better work load planning 0 Material savings from reduced packaging and use of... planning purposes, source distribution managers use the following equa- tion to determine maximum consolidation time: Maximum consolidation time = 21

Hospital steam sterilizer usage: could we switch off to save electricity and water?

PubMed

McGain, Forbes; Moore, Graham; Black, Jim

2016-07-01

Steam sterilization in hospitals is an energy and water intensive process. Our aim was to identify opportunities to improve electricity and water use. The objectives were to find: the time sterilizers spent active, idle and off; the variability in sterilizer use with the time of day and day of the week; and opportunities to switch off sterilizers instead of idling when no loads were waiting, and the resultant electricity and water savings. Analyses of routine data for one year of the activity of the four steam sterilizers in one hospital in Melbourne, Australia. We examined active sterilizer cycles, routine sterilizer switch-offs, and when sterilizers were active, idle and off. Several switch-off strategies were examined to identify electricity and water savings: switch off idle sterilizers when no loads are waiting and switch off one sterilizer after 10:00 h and a second sterilizer after midnight on all days. Sterilizers were active for 13,430 (38%) sterilizer-hours, off for 4822 (14%) sterilizer-hours, and idle for 16,788 (48%) sterilizer-hours. All four sterilizers were simultaneously active 9% of the time, and two or more sterilizers were idle for 69% of the time. A sterilizer was idle for two hours or less 13% of the time and idle for more than 2 h 87% of the time. A strategy to switch off idle sterilizers would reduce electricity use by 66 MWh and water use by 1004 kl per year, saving 26% electricity use and 13% of water use, resulting in financial savings of AUD$13,867 (UK£6,517) and a reduction in 79 tonnes of CO2 emissions per year. An alternative switch-off strategy of one sterilizer from 10:00 h onwards and a second from midnight would have saved 30 MWh and 456 kl of water. The methodology used of how hospital sterilizer use could be improved could be applied to all hospitals and more broadly to other equipment used in hospitals. © The Author(s) 2016.

Cost-minimization analysis favors outpatient quick diagnosis unit over hospitalization for the diagnosis of potentially serious diseases.

PubMed

Sanclemente-Ansó, Carmen; Bosch, Xavier; Salazar, Albert; Moreno, Ramón; Capdevila, Cristina; Rosón, Beatriz; Corbella, Xavier

2016-05-01

Quick diagnosis units (QDUs) are a promising alternative to conventional hospitalization for the diagnosis of suspected serious diseases, most commonly cancer and severe anemia. Although QDUs are as effective as hospitalization in reaching a timely diagnosis, a full economic evaluation comparing both approaches has not been reported. To evaluate the costs of QDU vs. conventional hospitalization for the diagnosis of cancer and anemia using a cost-minimization analysis on the proven assumption that health outcomes of both approaches were equivalent. Patients referred to the QDU of Bellvitge University Hospital of Barcelona over 51 months with a final diagnosis of severe anemia (unrelated to malignancy), lymphoma, and lung cancer were compared with patients hospitalized for workup with the same diagnoses. The total cost per patient until diagnosis was analyzed. Direct and non-direct costs of QDU and hospitalization were compared. Time to diagnosis in QDU patients (n=195) and length-of-stay in hospitalized patients (n=237) were equivalent. There were considerable costs savings from hospitalization. Highest savings for the three groups were related to fixed direct costs of hospital stays (66% of total savings). Savings related to fixed non-direct costs of structural and general functioning were 33% of total savings. Savings related to variable direct costs of investigations were 1% of total savings. Overall savings from hospitalization of all patients were €867,719.31. QDUs appear to be a cost-effective resource for avoiding unnecessary hospitalization in patients with anemia and cancer. Internists, hospital executives, and healthcare authorities should consider establishing this model elsewhere. Copyright © 2015. Published by Elsevier B.V.

Monitoring proton radiation therapy with in-room PET imaging

NASA Astrophysics Data System (ADS)

Zhu, Xuping; España, Samuel; Daartz, Juliane; Liebsch, Norbert; Ouyang, Jinsong; Paganetti, Harald; Bortfeld, Thomas R.; El Fakhri, Georges

2011-07-01

We used a mobile positron emission tomography (PET) scanner positioned within the proton therapy treatment room to study the feasibility of proton range verification with an in-room, stand-alone PET system, and compared with off-line equivalent studies. Two subjects with adenoid cystic carcinoma were enrolled into a pilot study in which in-room PET scans were acquired in list-mode after a routine fractionated treatment session. The list-mode PET data were reconstructed with different time schemes to generate in-room short, in-room long and off-line equivalent (by skipping coincidences from the first 15 min during the list-mode reconstruction) PET images for comparison in activity distribution patterns. A phantom study was followed to evaluate the accuracy of range verification for different reconstruction time schemes quantitatively. The in-room PET has a higher sensitivity compared to the off-line modality so that the PET acquisition time can be greatly reduced from 30 to <5 min. Features in deep-site, soft-tissue regions were better retained with in-room short PET acquisitions because of the collection of 15O component and lower biological washout. For soft tissue-equivalent material, the distal fall-off edge of an in-room short acquisition is deeper compared to an off-line equivalent scan, indicating a better coverage of the high-dose end of the beam. In-room PET is a promising low cost, high sensitivity modality for the in vivo verification of proton therapy. Better accuracy in Monte Carlo predictions, especially for biological decay modeling, is necessary.

Process Improvement Initiative for the Perioperative Management of Patients With a Cardiovascular Implantable Electronic Device.

PubMed

Ellis, Margaret K Menzel; Treggiari, Miriam M; Robertson, Jamie M; Rozner, Marc A; Graven, Peter F; Aziz, Michael F; Merkel, Matthias J; Kahl, Edward A; Cohen, Norman A; Stecker, Eric C; Schulman, Peter M

2017-07-01

Economic, personnel, and procedural challenges often complicate and interfere with efficient and safe perioperative care of patients with cardiovascular implantable electronic devices (CIEDs). In the context of a process improvement initiative, we created and implemented a comprehensive anesthesiologist-run perioperative CIED service to respond to all routine requests for perioperative CIED consultations at a large academic medical center. This study was designed to determine whether this new care model was associated with improved operating room efficiency, reduced institutional cost, and adequate patient safety. We included patients with a CIED and a concurrent cohort of patients with the same eligibility criteria but without a CIED who underwent first-case-of-the-day surgery during the periods between February 1, 2008, and August 17, 2010 (preintervention) and between March 4, 2012, and August 1, 2014 (postintervention). The primary end point was delay in first-case-of-the day start time. We used multiple linear regression to compare delays in start times during the preintervention and postintervention periods and to adjust for potential confounders. A patient safety database was queried for CIED-related complications. Cost analysis was based on labor minutes saved and was calculated using nationally published administrative estimates. A total of 18,148 first-case surgical procedures were performed in 15,100 patients (preintervention period-7293 patients and postintervention period-7807 patients). Of those, 151 (2.1%) patients had a CIED in the preintervention period, and 146 (1.9%) had a CIED in the postintervention period. After adjustment for imbalances in baseline characteristics (age, American Society of Anesthesiologists physical status, and surgical specialty), the difference in mean first-case start delay between the postintervention and preintervention periods in the cohort of patients with a CIED was -16.7 minutes (95% confidence interval [CI], -26.1 to -7.2). The difference in mean delay between the postintervention and preintervention periods in the cohort without a CIED was -4.7 minutes (95% CI, -5.4 to -3.9). There were 3 CIED-related adverse events during the preintervention period and none during the postintervention period. Based on reduction in first-case start delay, the intervention was associated with cost savings (estimated institutional savings $14,102 annually, or $94.06 per CIED patient), with a return on investment ratio of 2.18 over the course of the postintervention period. Based on our experience, specially trained anesthesiologists can provide efficient and safe perioperative care for patients with CIEDs. Other centers may consider implementing a similar strategy as our specialty adopts the perioperative surgical home model.

[Medicating outside the consulting room].

PubMed

Major, Csilla; Vincze, Zoltán; Meskó, Attiláné; Balogh, Judit; Zelkó, Romána; Németh, Erzsébet

2007-02-18

Self-medication is a means, besides changing one's lifestyle, of buying and taking non-prescription medicaments. This practice has several advantages. People save time and energy by not sitting for hours in the consulting room of the doctor with a simple ailment, and the doctors also have more time to deal with those requiring more serious treatment. Moreover, the expenditures of the state also decrease, as patients do not visit the doctor but buy non-prescription, i.e. non-supported, medicaments. The authors surveyed the habits and demands of a survey population concerning non-prescription medicaments, primarily in the pharmacies of Fejér county. A marketing research programme was completed in order to establish better co-operation between patients and pharmacists, within the framework of which 1450 questionnaires were distributed from March to June in 2005, 743 of which were completed and evaluated. The authors examined, whether there were differences within the answers given to professional questions (questions 1-25 of the questionnaire) through sex, age, qualifications and earning power. Answers were analyzed by statistical methods. Statistical analyses were carried out with the SPSS 13.0 program group. Those results were published, where significant differences were found. Half of the respondents take medicaments regularly, 65% of them watch advertisements about medicaments several times a day. 40% of those surveyed consult a professionally-qualified person about their decision before buying non-prescription medicaments. The population obtains much information from the brochures enclosed with medicaments, and almost 70% of them read these brochures. According to their opinions, when buying non-prescription products, pharmacists always recommend other possibilities as well, and they give details about the information concerning the application of the medicaments. In order for people to use non-prescription products properly, it would be definitely necessary to elaborate a successful national education strategy. The population expects information concerning medicaments to be communicated in the pharmacies in an understandable way. It should be in the pharmacy where patients learn about the medicaments they take, where the pharmacist knows what other medicines have been prescribed by a doctor, and whether patients have any illnesses whereby they should not take other products.

Quantifying Adoption Rates and Energy Savings Over Time for Advanced Manufacturing Technologies

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

Hanes, Rebecca; Carpenter Petri, Alberta C; Riddle, Matt

Energy-efficient manufacturing technologies can reduce energy consumption and lower operating costs for an individual manufacturing facility, but increased process complexity and the resulting risk of disruption means that manufacturers may be reluctant to adopt such technologies. In order to quantify potential energy savings at scales larger than a single facility, it is necessary to account for how quickly and how widely the technology will be adopted by manufacturers. This work develops a methodology for estimating energy-efficient manufacturing technology adoption rates using quantitative, objectively measurable technology characteristics, including energetic, economic and technical criteria. Twelve technology characteristics are considered, and each characteristicmore » is assigned an importance weight that reflects its impact on the overall technology adoption rate. Technology characteristic data and importance weights are used to calculate the adoption score, a number between 0 and 1 that represents how quickly the technology is likely to be adopted. The adoption score is then used to estimate parameters for the Bass diffusion curve, which quantifies the change in the number of new technology adopters in a population over time. Finally, energy savings at the sector level are calculated over time by multiplying the number of new technology adopters at each time step with the technology's facility-level energy savings. The proposed methodology will be applied to five state-of-the-art energy-efficient technologies in the carbon fiber composites sector, with technology data obtained from the Department of Energy's 2016 bandwidth study. Because the importance weights used in estimating the Bass curve parameters are subjective, a sensitivity analysis will be performed on the weights to obtain a range of parameters for each technology. The potential energy savings for each technology and the rate at which each technology is adopted in the sector are quantified and used to identify the technologies which offer the greatest cumulative sector-level energy savings over a period of 20 years. Preliminary analysis indicates that relatively simple technologies, such as efficient furnaces, will be adopted more quickly and result in greater cumulative energy savings compared to more complex technologies that require process retrofitting, such as advanced control systems.« less

Soft-copy sonography: cost reduction sensitivity analysis in a pediatric hospital.

PubMed

Don, S; Albertina, M J; Ammann, D

1998-03-01

Our objective was to determine whether interpreting sonograms of pediatric patients using soft-copy (computer workstation) instead of laser-printed film could reduce costs for a pediatric radiology department. We used theoretic models of growth to analyze costs. The costs of a sonographic picture archiving and communication system (three interface devices, two workstations, a network server, maintenance expenses, and storage media costs) were compared with the potential savings of eliminating film and increasing technologist efficiency or reducing the number of technologists. The model was based on historic trends and future capitation estimates that will reduce fee-for-service reimbursement. The effects of varying the study volume and reducing technologists' work hours were analyzed. By converting to soft-copy interpretation, we saved 6 min 32 sec per examination by eliminating film processing waiting time, thus reducing examination time from 30 min to 24 min. During an average day of 27 examinations, 176 min were saved. However, 33 min a day were spent retrieving prior studies from long-term storage; thus, 143 extra minutes a day were available for scanning. This improved efficiency could result in five more sonograms a day obtained by converting to soft-copy interpretation, using existing staff and equipment. Alternatively, five examinations a day would equate to one half of a full-time equivalent technologists position. Our analysis of costs considered that the hospital's anticipated growth of sonography and the depreciation of equipment during 5 years resulted in a savings of more than $606,000. Increasing the examinations by just 200 sonograms in the first year and no further growth resulted in a savings of more than $96,000. If the number of sonograms stayed constant, elimination of film printing alone resulted in a loss of approximately $157,000; reduction of one half of a full-time equivalent technologist's position would recuperate approximately $134,000 of that loss. Soft-copy sonography can save money through improved technologist efficiency, thereby increasing the number of sonograms obtained and revenue generated. If the number of sonograms does not increase, elimination of printing costs and reduction of staff technologists will not result in a savings.

Program Helps Decompose Complicated Design Problems

NASA Technical Reports Server (NTRS)

Rogers, James L., Jr.

1993-01-01

Time saved by intelligent decomposition into smaller, interrelated problems. DeMAID is knowledge-based software system for ordering sequence of modules and identifying possible multilevel structure for design problem. Displays modules in N x N matrix format. Requires investment of time to generate and refine list of modules for input, it saves considerable amount of money and time in total design process, particularly new design problems in which ordering of modules has not been defined. Program also implemented to examine assembly-line process or ordering of tasks and milestones.

DOD Civilian and Contractor Workforces: Additional Cost Savings Data and Efficiencies Plan are Needed

DTIC Science & Technology

2016-10-01

reductions reported in average strength bNumber of reductions reported in full-time equivalents Note: DOD costs savings provided for the prior FY are...comparing costs from FY 2012 to FY 2017, and not each year in between. Further, officials stated that DOD did not include full- time equivalents ...Application FTE Full-time Equivalent NDAA National Defense Authorization Act This is a work of the U.S. government and is not subject to copyright

Year-Round Daylight Saving Time Study : Volume 2. Supporting Studies

DOT National Transportation Integrated Search

1975-06-01

This volume contains detailed background material in support of findings of the Interim Report. It includes the findings of a survey of attifudes towards daylight saving conducted by the National Opinion Research Center; description of sunrise and su...

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

PubMed

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

2018-04-19

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

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.

Life-cycle models of saving and the effect of the timing of divorce on retirement economic well-being.

PubMed

Fethke, C C

1989-05-01

The long-term effect of the current high rate of divorce upon the future economic status of individuals has not been thoroughly analyzed. This study reviews the retirement, precautionary, and bequest motives for saving, then evaluates how marriage dissolution may (a) decrease the family's savings rate, (b) cause shifts in the family's portfolio to assets with lower rates of return, and (c) destroy or deplete existing family assets. Whether divorce interrupts the savings process or destroys assets, it is unlikely that most individuals will be able to save enough in later life to overcome the loss. The long-term effect may well be that, in future years, we will recognize a new category of elderly poor, those who have experienced the dissolution of their marriage.

Lean management in academic surgery.

PubMed

Collar, Ryan M; Shuman, Andrew G; Feiner, Sandra; McGonegal, Amy K; Heidel, Natalie; Duck, Mary; McLean, Scott A; Billi, John E; Healy, David W; Bradford, Carol R

2012-06-01

Lean is a management system designed to enhance productivity by eliminating waste. Surgical practice offers many opportunities for improving efficiency. Our objective was to determine whether systematic implementation of lean thinking in an academic otolaryngology operating room improves efficiency and profitability and preserves team morale and educational opportunities. In an 18-month prospective quasi-experimental study, a multidisciplinary task force systematically implemented lean thinking within an otolaryngology operating room of an academic health system. Operating room turnover time and turnaround time were measured during a baseline period; an observer-effect period in which workers were made aware that their efficiency was being measured but before implementing lean changes; and an intervention period after redesign principles had been used. The impact on teamwork, morale, and surgical resident education were measured during the baseline and intervention periods through validated surveys. A profit model was applied to estimate the financial implications of the study. There was no difference between the baseline and observer-effect periods of the study for turnover time (p = 0.98) or turnaround time (p = 0.20). During the intervention period, the mean turnover time and turnaround time were significantly shorter than during the baseline period (29 vs 38 minutes; p < 0.001 and 69 vs 89 minutes; p < 0.001, respectively). The composite morale score suggested improved morale after implementation (p = 0.011). Educational metrics were unchanged before and after implementation. The annual opportunity revenue for the involved operating room is $330,000; when extrapolated throughout the operating rooms, lean thinking could create 6,500 hours of capacity annually. Application of lean management techniques to a single operating room and surgical service improved operating room efficiency and morale, sustained resident education, and can provide considerable financial gains when scaled to an entire academic surgical suite. Copyright © 2012. Published by Elsevier Inc.

Principles of continuous quality improvement applied to intravenous therapy.

PubMed

Dunavin, M K; Lane, C; Parker, P E

1994-01-01

Documentation of the application of the principles of continuous quality improvement (CQI) to the health care setting is crucial for understanding the transition from traditional management models to CQI models. A CQI project was designed and implemented by the IV Therapy Department at Lawrence Memorial Hospital to test the application of these principles to intravenous therapy and as a learning tool for the entire organization. Through a prototype inventory project, significant savings in cost and time were demonstrated using check sheets, flow diagrams, control charts, and other statistical tools, as well as using the Plan-Do-Check-Act cycle. As a result, a primary goal, increased time for direct patient care, was achieved. Eight hours per week in nursing time was saved, relationships between two work areas were improved, and $6,000 in personnel costs, storage space, and inventory were saved.

One Room Schools in Iowa.

ERIC Educational Resources Information Center

Ruth, Amy, Ed.

1994-01-01

This issue focuses on one-room school houses in Iowa. At one time, almost 14,000 one-room schools dotted Iowa's rural landscape. Articles explore Native American schools of the past and present, segregation of black students, and Amish schools. An article remembering one-room schools describes the early schools from 1830 to 1858, township schools…

7 CFR 58.412 - Coolers or curing rooms.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 3 2012-01-01 2012-01-01 false Coolers or curing rooms. 58.412 Section 58.412....412 Coolers or curing rooms. Coolers or curing rooms where cheese is held for curing or storage shall... times. The shelves shall be kept clean and dry. This does not preclude the maintenance of suitable...

7 CFR 58.412 - Coolers or curing rooms.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 3 2014-01-01 2014-01-01 false Coolers or curing rooms. 58.412 Section 58.412....412 Coolers or curing rooms. Coolers or curing rooms where cheese is held for curing or storage shall... times. The shelves shall be kept clean and dry. This does not preclude the maintenance of suitable...

7 CFR 58.412 - Coolers or curing rooms.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 3 2013-01-01 2013-01-01 false Coolers or curing rooms. 58.412 Section 58.412....412 Coolers or curing rooms. Coolers or curing rooms where cheese is held for curing or storage shall... times. The shelves shall be kept clean and dry. This does not preclude the maintenance of suitable...

7 CFR 58.412 - Coolers or curing rooms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Coolers or curing rooms. 58.412 Section 58.412....412 Coolers or curing rooms. Coolers or curing rooms where cheese is held for curing or storage shall... times. The shelves shall be kept clean and dry. This does not preclude the maintenance of suitable...

7 CFR 58.412 - Coolers or curing rooms.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 3 2011-01-01 2011-01-01 false Coolers or curing rooms. 58.412 Section 58.412....412 Coolers or curing rooms. Coolers or curing rooms where cheese is held for curing or storage shall... times. The shelves shall be kept clean and dry. This does not preclude the maintenance of suitable...

9 CFR 354.241 - Cleaning of rooms and compartments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... skinning room shall be kept clean and free from offensive odors at all times. (g) The walls, floors, and all equipment and utensils used in the killing and skinning room shall be thoroughly washed and cleaned after each day's operation. (h) The floor in the killing and skinning rooms shall be cleaned...

9 CFR 354.241 - Cleaning of rooms and compartments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... skinning room shall be kept clean and free from offensive odors at all times. (g) The walls, floors, and all equipment and utensils used in the killing and skinning room shall be thoroughly washed and cleaned after each day's operation. (h) The floor in the killing and skinning rooms shall be cleaned...

Operating room management and operating room productivity: the case of Germany.

PubMed

Berry, Maresi; Berry-Stölzle, Thomas; Schleppers, Alexander

2008-09-01

We examine operating room productivity on the example of hospitals in Germany with independent anesthesiology departments. Linked to anesthesiology group literature, we use the ln(Total Surgical Time/Total Anesthesiologists Salary) as a proxy for operating room productivity. We test the association between operating room productivity and different structural, organizational and management characteristics based on survey data from 87 hospitals. Our empirical analysis links improved operating room productivity to greater operating room capacity, appropriate scheduling behavior and management methods to realign interests. From this analysis, the enforcing jurisdiction and avoiding advance over-scheduling appear to be the implementable tools for improving operating room productivity.

Chapter 2: Commercial and Industrial Lighting Evaluation Protocol. The Uniform Methods Project: Methods for Determining Energy Efficiency Savings for Specific Measures

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

Kurnik, Charles W; Gowans, Dakers; Telarico, Chad

The Commercial and Industrial Lighting Evaluation Protocol (the protocol) describes methods to account for gross energy savings resulting from the programmatic installation of efficient lighting equipment in large populations of commercial, industrial, and other nonresidential facilities. This protocol does not address savings resulting from changes in codes and standards, or from education and training activities. A separate Uniform Methods Project (UMP) protocol, Chapter 3: Commercial and Industrial Lighting Controls Evaluation Protocol, addresses methods for evaluating savings resulting from lighting control measures such as adding time clocks, tuning energy management system commands, and adding occupancy sensors.

Air Conditioner/Dehumidifier

NASA Technical Reports Server (NTRS)

1986-01-01

An ordinary air conditioner in a very humid environment must overcool the room air, then reheat it. Mr. Dinh, a former STAC associate, devised a heat pipe based humidifier under a NASA Contract. The system used heat pipes to precool the air; the air conditioner's cooling coil removes heat and humidity, then the heat pipes restore the overcooled air to a comfortable temperature. The heat pipes use no energy, and typical savings are from 15-20%. The Dinh Company also manufactures a "Z" coil, a retrofit cooling coil which may be installed on an existing heater/air conditioner. It will also provide free hot water. The company has also developed a photovoltaic air conditioner and solar powered water pump.

Defining the Costs of Reusable Flexible Ureteroscope Reprocessing Using Time-Driven Activity-Based Costing.

PubMed

Isaacson, Dylan; Ahmad, Tessnim; Metzler, Ian; Tzou, David T; Taguchi, Kazumi; Usawachintachit, Manint; Zetumer, Samuel; Sherer, Benjamin; Stoller, Marshall; Chi, Thomas

2017-10-01

Careful decontamination and sterilization of reusable flexible ureteroscopes used in ureterorenoscopy cases prevent the spread of infectious pathogens to patients and technicians. However, inefficient reprocessing and unavailability of ureteroscopes sent out for repair can contribute to expensive operating room (OR) delays. Time-driven activity-based costing (TDABC) was applied to describe the time and costs involved in reprocessing. Direct observation and timing were performed for all steps in reprocessing of reusable flexible ureteroscopes following operative procedures. Estimated times needed for each step by which damaged ureteroscopes identified during reprocessing are sent for repair were characterized through interviews with purchasing analyst staff. Process maps were created for reprocessing and repair detailing individual step times and their variances. Cost data for labor and disposables used were applied to calculate per minute and average step costs. Ten ureteroscopes were followed through reprocessing. Process mapping for ureteroscope reprocessing averaged 229.0 ± 74.4 minutes, whereas sending a ureteroscope for repair required an estimated 143 minutes per repair. Most steps demonstrated low variance between timed observations. Ureteroscope drying was the longest and highest variance step at 126.5 ± 55.7 minutes and was highly dependent on manual air flushing through the ureteroscope working channel and ureteroscope positioning in the drying cabinet. Total costs for reprocessing totaled $96.13 per episode, including the cost of labor and disposable items. Utilizing TDABC delineates the full spectrum of costs associated with ureteroscope reprocessing and identifies areas for process improvement to drive value-based care. At our institution, ureteroscope drying was one clearly identified target area. Implementing training in ureteroscope drying technique could save up to 2 hours per reprocessing event, potentially preventing expensive OR delays.

Determination of secondhand smoke leakage from the smoking room of an Internet café.

PubMed

Kim, Hyejin; Lee, Kiyoung; An, Jaehoon; Won, Sungho

2017-10-01

Although Internet cafes have been designated as nonsmoking areas in Korea, smoke-free legislation has allowed the installation of indoor smoking rooms. The purposes of this study were to determine secondhand smoke (SHS) leakage from an Internet café smoking room and to identify factors associated with SHS leakage. PM 2.5 (particulate matter with an aerodynamic diameter ≤2.5 μm) mass concentrations were measured simultaneously both inside and outside the door to the smoking room. During each measurement, a field technician observed how long the smoking room door was opened and closed, the direction of door opening, and the number of smokers. A multivariate linear regression model was used to identify the causality of SHS leakage from the smoking room. A time series of PM 2.5 concentrations both inside and outside the door to the smoking room showed a similar trend. SHS leakage was significantly increased because of factors associated with the direction of the smoking room door being opened, the duration of how long the smoking room door was opened until it was closed, and the average PM 2.5 concentration inside the smoking room when the door was opened. SHS leakage from inside the smoking room to outside the smoking room was evident especially when the smoking room door was opened. Since the smoking room is not effective in preventing SHS exposure, the smoking room should be removed from the facilities to protect citizens from SHS exposure through revision of the current legislation, which permits installation of a smoking room. This paper concerns secondhand smoke (SHS) leakage from indoor smoking room. Unlike previous studies, the authors statistically analyzed the causality of PM 2.5 concentration leakage from a smoking room using time-series analysis. Since the authors selected the most common smoking room, the outcomes could be generalized. The study demonstrated that SHS leakage from smoking room and SHS leakage were clearly associated with door opening. The finding demonstrated ineffectiveness of smoking room to protect citizens and supports removal of indoor smoking room.

A cost-consequences analysis of a primary care librarian question and answering service.

PubMed

McGowan, Jessie; Hogg, William; Zhong, Jianwei; Zhao, Xue

2012-01-01

Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.

Outplacement Services in Support of BRAC and Competitive Sourcing Task Group

DTIC Science & Technology

2003-07-30

Management(SM) is an automated Web-based solution that streamlines workforce adjustment initiatives and exit processing, saving time and money by getting...effected during FY02 – almost 7,000. o Over 160,000 employees have been saved from involuntary separation since program inception in 1993. Buyouts...monetary incentive, up to $25,000, for employee to retire, either optional or early, or resign. Payment of the incentive must save another DoD employee

Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

PubMed

Read-Brown, Sarah; Sanders, David S; Brown, Anna S; Yackel, Thomas R; Choi, Dongseok; Tu, Daniel C; Chiang, Michael F

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design.

Time-Motion Analysis of Clinical Nursing Documentation During Implementation of an Electronic Operating Room Management System for Ophthalmic Surgery

PubMed Central

Read-Brown, Sarah; Sanders, David S.; Brown, Anna S.; Yackel, Thomas R.; Choi, Dongseok; Tu, Daniel C.; Chiang, Michael F.

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design. PMID:24551402

Buying time promotes happiness.

PubMed

Whillans, Ashley V; Dunn, Elizabeth W; Smeets, Paul; Bekkers, Rene; Norton, Michael I

2017-08-08

Around the world, increases in wealth have produced an unintended consequence: a rising sense of time scarcity. We provide evidence that using money to buy time can provide a buffer against this time famine, thereby promoting happiness. Using large, diverse samples from the United States, Canada, Denmark, and The Netherlands ( n = 6,271), we show that individuals who spend money on time-saving services report greater life satisfaction. A field experiment provides causal evidence that working adults report greater happiness after spending money on a time-saving purchase than on a material purchase. Together, these results suggest that using money to buy time can protect people from the detrimental effects of time pressure on life satisfaction.

Buying time promotes happiness

PubMed Central

Whillans, Ashley V.; Dunn, Elizabeth W.; Smeets, Paul; Bekkers, Rene; Norton, Michael I.

2017-01-01

Around the world, increases in wealth have produced an unintended consequence: a rising sense of time scarcity. We provide evidence that using money to buy time can provide a buffer against this time famine, thereby promoting happiness. Using large, diverse samples from the United States, Canada, Denmark, and The Netherlands (n = 6,271), we show that individuals who spend money on time-saving services report greater life satisfaction. A field experiment provides causal evidence that working adults report greater happiness after spending money on a time-saving purchase than on a material purchase. Together, these results suggest that using money to buy time can protect people from the detrimental effects of time pressure on life satisfaction. PMID:28739889

Oxygen concentrators for the delivery of supplemental oxygen in remote high-altitude areas.

PubMed

Litch, J A; Bishop, R A

2000-01-01

Oxygen concentrators are a relatively new technology for the delivery of supplemental oxygen. Readily available for domicile use in modern countries, these machines have proved reliable. The application of oxygen concentrators for the supply of medical oxygen in remote high-altitude settings has important cost-saving and supply implications. In our experience at a remote hospital at 3,900 m in the Nepal Himalayas, oxygen concentrators constitute an effective and affordable means to supply medical oxygen. Using an air compressor and 2 zeolite chambers, the machine traps nitrogen from room air compressed to 4 atm, thus concentrating oxygen in the expressed gas. At delivery flow rates of 2 to 5 liters per minute, oxygen concentrations greater than 80% can be maintained. An electric power requirement of less than 400 W can be provided from a variety of sources, including a small gasoline generator, a solar or wind power system with battery store, or a domestic or commercial power source. At our facility, a cost savings of 75% for supplemental oxygen was found in favor of the oxygen concentrator over cylinders (0.17 US cents per liter vs 0.79 US cents per liter).

Fresh Veggies from Space

NASA Technical Reports Server (NTRS)

2001-01-01

Professor Marc Anderson of the University of Wisconsin-Madison developed a technology for use in plant-growth experiments aboard the Space Shuttle. Anderson's research and WCSAR's technology were funded by NASA and resulted in a joint technology licensed to KES Science and Technology, Inc. This transfer of space-age technology resulted in the creation of a new plant-saving product, an ethylene scrubber for plant growth chambers. This innovation presents commercial benefits for the food industry in the form of a new device, named Bio-KES. Bio-KES removes ethylene and helps to prevent spoilage. Ethylene accounts for up to 10 percent of produce losses and 5 percent of flower losses. Using Bio-KES in storage rooms and displays will increase the shelf life of perishable foods by more than one week, drastically reducing the costs associated with discarded rotten foods and flowers. The savings could potentially be passed on to consumers. For NASA, the device means that astronauts can conduct commercial agricultural research in space. Eventually, it may also help to grow food in space and keep it fresh longer. This could lead to less packaged food being taken aboard missions since it could be cultivated in an ethylene-free environment.

Building Intrusion Detection with a Wireless Sensor Network

NASA Astrophysics Data System (ADS)

Wälchli, Markus; Braun, Torsten

This paper addresses the detection and reporting of abnormal building access with a wireless sensor network. A common office room, offering space for two working persons, has been monitored with ten sensor nodes and a base station. The task of the system is to report suspicious office occupation such as office searching by thieves. On the other hand, normal office occupation should not throw alarms. In order to save energy for communication, the system provides all nodes with some adaptive short-term memory. Thus, a set of sensor activation patterns can be temporarily learned. The local memory is implemented as an Adaptive Resonance Theory (ART) neural network. Unknown event patterns detected on sensor node level are reported to the base station, where the system-wide anomaly detection is performed. The anomaly detector is lightweight and completely self-learning. The system can be run autonomously or it could be used as a triggering system to turn on an additional high-resolution system on demand. Our building monitoring system has proven to work reliably in different evaluated scenarios. Communication costs of up to 90% could be saved compared to a threshold-based approach without local memory.

Value drivers: an approach for estimating health and disease management program savings.

PubMed

Phillips, V L; Becker, Edmund R; Howard, David H

2013-12-01

Health and disease management (HDM) programs have faced challenges in documenting savings related to their implementation. The objective of this eliminate study was to describe OptumHealth's (Optum) methods for estimating anticipated savings from HDM programs using Value Drivers. Optum's general methodology was reviewed, along with details of 5 high-use Value Drivers. The results showed that the Value Driver approach offers an innovative method for estimating savings associated with HDM programs. The authors demonstrated how real-time savings can be estimated for 5 Value Drivers commonly used in HDM programs: (1) use of beta-blockers in treatment of heart disease, (2) discharge planning for high-risk patients, (3) decision support related to chronic low back pain, (4) obesity management, and (5) securing transportation for primary care. The validity of savings estimates is dependent on the type of evidence used to gauge the intervention effect, generating changes in utilization and, ultimately, costs. The savings estimates derived from the Value Driver method are generally reasonable to conservative and provide a valuable framework for estimating financial impacts from evidence-based interventions.

Planning for patient privacy and hospitability: a must do in oncology care.

PubMed

Easter, James G

2003-01-01

The number one design challenge in the healthcare environment is the patient room. This space is one of the primary functional areas impacting hospital design and, quite often, the place of greatest controversy. This controversy is due to the length of time the patient spends in the room (compared to other areas), the amount of overall space required and the time dedicated to patient room utilization, maintenance, general arrangement and overall efficiency. In addition, there is a growing list of room types to be considered, many are of the ambulatory care, short stay and observation category. Other room types beyond the routine medical/surgical room include Intensive Care, Coronary Care, Surgical Intensive Care, Skilled Nursing, Rehabilitation and Oncology Care as well as more intensive Bone Marrow Transplantation, for example. Major features of the traditional acute care patient room require the space to be flexible, convertible, expandable and, most importantly, hospitable. For many, many years the patient room was considered a shared space with multiple beds and multiple users. The term semi-private has been used to describe the traditional two-bed and, sometimes 4-bed patient room. This article will address the programmatic elements of an inpatient area, the room and its functional components along with some examples for comparative purposes. For the oncology patient, the development of a family-focused, private room is mandatory. The private room is more flexible, less expensive to operate, safer and environmentally more appealing for the patient, family and staff.

Orphan therapies: making best use of postmarket data.

PubMed

Maro, Judith C; Brown, Jeffrey S; Dal Pan, Gerald J; Li, Lingling

2014-08-01

Postmarket surveillance of the comparative safety and efficacy of orphan therapeutics is challenging, particularly when multiple therapeutics are licensed for the same orphan indication. To make best use of product-specific registry data collected to fulfill regulatory requirements, we propose the creation of a distributed electronic health data network among registries. Such a network could support sequential statistical analyses designed to detect early warnings of excess risks. We use a simulated example to explore the circumstances under which a distributed network may prove advantageous. We perform sample size calculations for sequential and non-sequential statistical studies aimed at comparing the incidence of hepatotoxicity following initiation of two newly licensed therapies for homozygous familial hypercholesterolemia. We calculate the sample size savings ratio, or the proportion of sample size saved if one conducted a sequential study as compared to a non-sequential study. Then, using models to describe the adoption and utilization of these therapies, we simulate when these sample sizes are attainable in calendar years. We then calculate the analytic calendar time savings ratio, analogous to the sample size savings ratio. We repeat these analyses for numerous scenarios. Sequential analyses detect effect sizes earlier or at the same time as non-sequential analyses. The most substantial potential savings occur when the market share is more imbalanced (i.e., 90% for therapy A) and the effect size is closest to the null hypothesis. However, due to low exposure prevalence, these savings are difficult to realize within the 30-year time frame of this simulation for scenarios in which the outcome of interest occurs at or more frequently than one event/100 person-years. We illustrate a process to assess whether sequential statistical analyses of registry data performed via distributed networks may prove a worthwhile infrastructure investment for pharmacovigilance.

The shift to and from daylight savings time and motor vehicle crashes.

PubMed

Lambe, M; Cummings, P

2000-07-01

The objective of the study was to examine whether the shifts to and from daylight savings time in Sweden have short-term effects on the incidence of traffic crashes. A database maintained by the Swedish National Road Administration was used to examine crashes from 1984 through 1995, that occurred on state roads the Monday preceding, the Monday immediately after (index Monday), and the Monday 1 week after the change to daylight savings time in the spring and for the corresponding three Mondays in the autumn. The Mondays 1 week before and after the time changes were taken as representing the expected incidence of crashes. Crash incidence was calculated per 1000 person-years using population estimates for each year of the study. The association between 1 h of possible sleep loss and crash incidence was estimated by the incidence rate ratio from negative binomial regression. The incidence rate ratio was 1.04 (95% CI, 0.92-1.16) for a Monday on which drivers were expected to have had 1 h less sleep, compared with other Mondays. In the spring, the incidence rate ratio for crashes was 1.11 (95% CI, 0.93-1.31) for Mondays after the time change compared to other spring Mondays. The corresponding rate ratio for the fall was 0.98 (95% CI, 0.84-1.15) It was concluded that the shift to and from daylight savings time did not have measurable important immediate effects on crash incidence in Sweden.

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department.

PubMed

Thomas, Anita A; Uspal, Neil G; Oron, Assaf P; Klein, Eileen J

2016-12-01

Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills ( P  < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use ( P  = .30, paired difference -0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use ( P  < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use ( P  < .05, paired difference -0.4 points). Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training.

Perceptions on the Impact of a Just-in-Time Room on Trainees and Supervising Physicians in a Pediatric Emergency Department

PubMed Central

Thomas, Anita A.; Uspal, Neil G.; Oron, Assaf P.; Klein, Eileen J.

2016-01-01

Background  Just-in-time (JIT) training refers to education occurring immediately prior to clinical encounters. An in situ JIT room in a pediatric emergency department (ED) was created for procedural education. Objective  We examined trainee self-reported JIT room use, its impact on trainee self-perception of procedural competence/confidence, and the effect its usage has on the need for intervention by supervising physicians during procedures. Methods  Cross-sectional survey study of a convenience sample of residents rotating through the ED and supervising pediatric emergency medicine physicians. Outcomes included JIT room use, trainee procedural confidence, and frequency of supervisor intervention during procedures. Results  Thirty-one of 32 supervising physicians (97%) and 122 of 186 residents (66%) completed the survey, with 71% of trainees reporting improved confidence, and 68% reporting improved procedural skills (P < .05, +1.4-point average skills improvement on a 5-point Likert scale). Trainees perceived no difference among supervising physicians intervening in procedures with or without JIT room use (P = .30, paired difference −0.0 points). Nearly all supervisors reported improved trainee procedural confidence, and 77% reported improved trainee procedural skills after JIT room use (P < .05, paired difference +1.8 points); 58% of supervisors stated they intervene in procedures without trainee JIT room use, compared with 42% with JIT room use (P < .05, paired difference −0.4 points). Conclusions  Use of the JIT room led to improved trainee confidence and supervisor reports of less procedural intervention. Although it carries financial and time costs, an in situ JIT room may be important for convenient JIT training. PMID:28018542

Challenges and solutions for realistic room simulation

NASA Astrophysics Data System (ADS)

Begault, Durand R.

2002-05-01

Virtual room acoustic simulation (auralization) techniques have traditionally focused on answering questions related to speech intelligibility or musical quality, typically in large volumetric spaces. More recently, auralization techniques have been found to be important for the externalization of headphone-reproduced virtual acoustic images. Although externalization can be accomplished using a minimal simulation, data indicate that realistic auralizations need to be responsive to head motion cues for accurate localization. Computational demands increase when providing for the simulation of coupled spaces, small rooms lacking meaningful reverberant decays, or reflective surfaces in outdoor environments. Auditory threshold data for both early reflections and late reverberant energy levels indicate that much of the information captured in acoustical measurements is inaudible, minimizing the intensive computational requirements of real-time auralization systems. Results are presented for early reflection thresholds as a function of azimuth angle, arrival time, and sound-source type, and reverberation thresholds as a function of reverberation time and level within 250-Hz-2-kHz octave bands. Good agreement is found between data obtained in virtual room simulations and those obtained in real rooms, allowing a strategy for minimizing computational requirements of real-time auralization systems.

Effects of single-family rooms on nurse-parent and nurse-infant interaction in neonatal intensive care unit.

PubMed

Toivonen, Mirka; Lehtonen, Liisa; Löyttyniemi, Eliisa; Axelin, Anna

Single-family rooms in neonatal intensive care unit can provide longer interaction between family and staff. On the other hand, separation in private rooms has been shown detrimental to child development if parents are not present. To examine the effects of single-family rooms on nurse-family, nurse-parent and nurse-infant interaction time in neonatal intensive care unit. A quantitative, comparative, observational study was conducted before and after a move to a neonatal intensive care unit with single-family rooms. A total of 194 observation hours were conducted before the move and 194h after the move. The differences were analyzed using a hierarchical linear mixed model. Nurses working in one neonatal intensive care unit were recruited to study. The duration and number of nurse-parent and nurse-infant interaction episodes were recorded. The nurse-family and the nurse-parent interaction were longer in the unit with single-family rooms compared with the unit before the move (mean 261 vs. 138min per shift, p<0.0001 and 117 vs. 35, p=0.001, respectively). The duration of the nurse-infant interaction did not change after the move. The frequency of the nurse-parent or the nurse-infant interactions did not change between the time periods. Neonatal intensive care unit with single-family rooms supported an increase in nurse-parent interaction time. Importantly, nurse-infant interaction time did not decrease. Copyright © 2017 Elsevier B.V. All rights reserved.

Heated tool for autoclaves

NASA Technical Reports Server (NTRS)

Serafini, T. T.; Vanucci, R. D.; Cavano, P. J.; Winters, W. E.

1980-01-01

Components made of composite materials are heated in autoclaves by employing electrical resistance heating blankets, thus avoiding need to heat entire autoclave volume. Method provides not only significant energy savings compared to heating entire pressure vessel but offers time savings in accelerated heat-up and cool-down cycles.

Cool Shelter

ERIC Educational Resources Information Center

Praeger, Charles E.

2005-01-01

Amid climbing energy costs and tightening budgets, administrators at school districts, colleges and universities are looking for all avenues of potential savings while promoting sustainable communities. Cool metal roofing can save schools money and promote sustainable design at the same time. Cool metal roofing keeps the sun's heat from collecting…

Direct and indirect costs and potential cost savings of laparoscopic adjustable gastric banding among obese patients with diabetes.

PubMed

Finkelstein, Eric A; Allaire, Benjamin T; DiBonaventura, Marco DaCosta; Burgess, Somali M

2011-09-01

To estimate the time to breakeven and 5-year net costs for laparoscopic adjustable gastric banding among obese patients with diabetes taking direct and indirect costs into account. Indirect cost savings were generated by quantifying the cross-sectional relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and simulating indirect cost savings based on these multipliers and reductions in direct medical costs available in the literature. Time to breakeven was estimated to be nine quarters with and without the inclusion of indirect costs. After 5 years, net savings increase from $26570 (±$9000) to $34160 (±$10 380) when indirect costs are included. This study presented a novel approach for incorporating indirect costs into cost-benefit analyses. Application to gastric banding revealed that inclusion of indirect costs improves the financial outlook for the procedure. (C)2011The American College of Occupational and Environmental Medicine

An Adaptive Intelligent Integrated Lighting Control Approach for High-Performance Office Buildings

NASA Astrophysics Data System (ADS)

Karizi, Nasim

An acute and crucial societal problem is the energy consumed in existing commercial buildings. There are 1.5 million commercial buildings in the U.S. with only about 3% being built each year. Hence, existing buildings need to be properly operated and maintained for several decades. Application of integrated centralized control systems in buildings could lead to more than 50% energy savings. This research work demonstrates an innovative adaptive integrated lighting control approach which could achieve significant energy savings and increase indoor comfort in high performance office buildings. In the first phase of the study, a predictive algorithm was developed and validated through experiments in an actual test room. The objective was to regulate daylight on a specified work plane by controlling the blind slat angles. Furthermore, a sensor-based integrated adaptive lighting controller was designed in Simulink which included an innovative sensor optimization approach based on genetic algorithm to minimize the number of sensors and efficiently place them in the office. The controller was designed based on simple integral controllers. The objective of developed control algorithm was to improve the illuminance situation in the office through controlling the daylight and electrical lighting. To evaluate the performance of the system, the controller was applied on experimental office model in Lee et al.'s research study in 1998. The result of the developed control approach indicate a significantly improvement in lighting situation and 1-23% and 50-78% monthly electrical energy savings in the office model, compared to two static strategies when the blinds were left open and closed during the whole year respectively.

[Effects of acaoustic adaptation of classrooms on the quality of verbal communication].

PubMed

Mikulski, Witold

2013-01-01

Voice organ disorders among teachers are caused by excessive voice strain. One of the measures to reduce this strain is to decrease background noise when teaching. Increasing the acoustic absorption of the room is a technical measure for achieving this aim. The absorption level also improves speech intelligibility rated by the following parameters: room reverberation time and speech transmission index (STI). This article presents the effects of acoustic adaptation of classrooms on the quality of verbal communication, aimed at getting the speech intelligibility at the good or excellent level. The article lists the criteria for evaluating classrooms in terms of the quality of verbal communication. The parameters were defined, using the measurement methods according to PN-EN ISO 3382-2:2010 and PN-EN 60268-16:2011. Acoustic adaptations were completed in two classrooms. After completing acoustic adaptations the reverberation time for the frequency of 1 kHz was reduced: in room no. 1 from 1.45 s to 0.44 s and in room no. 2 from 1.03 s to 0.37 s (maximum 0.65 s). At the same time, the speech transmission index increased: in room no. 1 from 0.55 (satisfactory speech intelligibility) to 0.75 (speech intelligibility close to excellent); in room no. 2 from 0.63 (good speech intelligibility) to 0.80 (excellent speech intelligibility). Therefore, it can be stated that prior to completing acoustic adaptations room no. 1 did not comply and room no. 2 barely complied with the criterion (speech transmission index of 0.62). After completing acoustic adaptations both rooms meet the requirements.

Measuring quality indicators in the operating room: cleaning and turnover time.

PubMed

Jericó, Marli de Carvalho; Perroca, Márcia Galan; da Penha, Vivian Colombo

2011-01-01

This exploratory-descriptive study was carried out in the Surgical Center Unit of a university hospital aiming to measure time spent with concurrent cleaning performed by the cleaning service and turnover time and also investigated potential associations between cleaning time and the surgery's magnitude and specialty, period of the day and the room's size. The sample consisted of 101 surgeries, computing cleaning time and 60 surgeries, computing turnover time. The Kaplan-Meier method was used to analyze time and Pearson's correlation to study potential correlations. The time spent in concurrent cleaning was 7.1 minutes and turnover time was 35.6 minutes. No association between cleaning time and the other variables was found. These findings can support nurses in the efficient use of resources thereby speeding up the work process in the operating room.

Mathematical model of marine diesel engine simulator for a new methodology of self propulsion tests

NASA Astrophysics Data System (ADS)

Izzuddin, Nur; Sunarsih, Priyanto, Agoes

2015-05-01

As a vessel operates in the open seas, a marine diesel engine simulator whose engine rotation is controlled to transmit through propeller shaft is a new methodology for the self propulsion tests to track the fuel saving in a real time. Considering the circumstance, this paper presents the real time of marine diesel engine simulator system to track the real performance of a ship through a computer-simulated model. A mathematical model of marine diesel engine and the propeller are used in the simulation to estimate fuel rate, engine rotating speed, thrust and torque of the propeller thus achieve the target vessel's speed. The input and output are a real time control system of fuel saving rate and propeller rotating speed representing the marine diesel engine characteristics. The self-propulsion tests in calm waters were conducted using a vessel model to validate the marine diesel engine simulator. The simulator then was used to evaluate the fuel saving by employing a new mathematical model of turbochargers for the marine diesel engine simulator. The control system developed will be beneficial for users as to analyze different condition of vessel's speed to obtain better characteristics and hence optimize the fuel saving rate.

Evaluating the fair market value of pay for performance.

PubMed

Johnson, Jen; Higgins, Alexandra

2014-04-01

When assessing a pay-for-performance arrangement, the following factors should be considered: Existence and/or size of minimum savings threshold before savings are allocated. Savings allocation percentage available to physicians. Benchmarks used to measure quality against past performance and/or medical evidence. Ways in which quality outcomes are measured and paid for. Per member per month payments for patient management. Physician investment (participation fee, time, or capital). Existence of downside risk to physicians. Employed compensation structure (if applicable).

Disaster Relief and Emergency Medical Services Project (DREAMS TM): Digital EMS

DTIC Science & Technology

2000-10-01

exchanges between the hospital and the EMS vehicle. By creating the virtual presence of a physician at or near the emergency scene, more lives will be saved ...address, cross street, zip code etc. The map can be saved to the clipboard or to an EMF graphics file for use by other applications in the system. 29...section can be found in Appendix B. The EMS personnel on board the ambulance can benefit greatly from technology integration. Several time- saving

Design of electric vehicle charging station based on wind and solar complementary power supply

NASA Astrophysics Data System (ADS)

Wang, Li

2018-05-01

Electric vehicles have become a major trend in the development of the automobile industry. Green energy saving is an important feature of their development. At the same time, the related charging facilities construction is also critical. If we improve the charging measures to adapt to its green energy-saving features, it will be to a greater extent to promote its further development. This article will propose a highly efficient green energy-saving charging station designed for the electric vehicles.

Are virtual planning and guided surgery for head and neck reconstruction economically viable?

PubMed

Zweifel, Daniel Fritz; Simon, Christian; Hoarau, Remy; Pasche, Philippe; Broome, Martin

2015-01-01

Virtual planning and guided surgery with or without prebent or milled plates are becoming more and more common for mandibular reconstruction with fibular free flaps (FFFs). Although this excellent surgical option is being used more widely, the question of the additional cost of planning and cutting-guide production has to be discussed. In capped payment systems such additional costs have to be offset by other savings if there are no special provisions for extra funding. Our study was designed to determine whether using virtual planning and guided surgery resulted in time saved during surgery and whether this time gain resulted in self-funding of such planning through the time saved. All consecutive cases of FFF surgery were evaluated during a 2-year period. Institutional data were used to determine the price of 1 minute of operative time. The time for fibula molding, plate adaptation, and insetting was recorded. During the defined period, we performed 20 mandibular reconstructions using FFFs, 9 with virtual planning and guided surgery and 11 freehand cases. One minute of operative time was calculated to cost US $47.50. Multiplying this number by the time saved, we found that the additional cost of virtual planning was reduced from US $5,098 to US $1,231.50 with a prebent plate and from US $6,980 to US $3,113.50 for a milled plate. Even in capped health care systems, virtual planning and guided surgery including prebent or milled plates are financially viable. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

[How many patient transfer rooms are necessary for my OR suite? : Effect of the number of OR transfer rooms on waiting times and patient throughput in the OR - analysis by simulation].

PubMed

Messer, C; Zander, A; Arnolds, I V; Nickel, S; Schuster, M

2015-12-01

In most hospitals the operating rooms (OR) are separated from the rest of the hospital by transfer rooms where patients have to pass through for reasons of hygiene. In the OR transfer room patients are placed on the OR table before surgery and returned to the hospital bed after surgery. It could happen that the number of patients who need to pass through a transfer room at a certain point in time exceed the number of available transfer rooms. As a result the transfer rooms become a bottleneck where patients have to wait and which, in turn, may lead to delays in the OR suite. In this study the ability of a discrete event simulation to analyze the effect of the duration of surgery and the number of ORs on the number of OR transfer rooms needed was investigated. This study was based on a discrete event simulation model developed with the simulation software AnyLogic®. The model studied the effects of the number of OR transfer rooms on the processes in an OR suite of a community hospital by varying the number of ORs from one to eight and using different surgical portfolios. Probability distributions for the process duration of induction, surgery and recovery and transfer room processes were calculated on the basis of real data from the community hospital studied. Furthermore, using a generic simulation model the effect of the average duration of surgery on the number of OR transfer rooms needed was examined. The discrete event simulation model enabled the analysis of both quantitative as well as qualitative changes in the OR process and setting. Key performance indicators of the simulation model were patient throughput per day, the probability of waiting and duration of waiting time in front of OR transfer rooms. In the case of a community hospital with 1 transfer room the average proportion of patients waiting before entering the OR was 17.9 % ± 9.7 % with 3 ORs, 37.6 % ± 9.7 % with 5 ORs and 62.9 % ± 9.1 % with 8 ORs. The average waiting time of patients in the setting with 3 ORs was 3.1 ± 2.7 min, with 5 ORs 5.0 ± 5.8 min and with 8 ORs 11.5 ± 12.5 min. Based on this study the community hospital needs a second transfer room starting from 4 ORs so that there is no bottleneck for the subsequent OR processes. The average patient throughput in a setting with 4 ORs increased significantly by 0.3 patients per day when a second transfer room is available. The generic model showed a strong effect of the average duration of surgery on the number of transfer rooms needed. There was no linear correlation between the number of transfer rooms and the number of ORs. The shorter the average duration of surgery, the earlier an additional transfer room is required. Thus, hospitals with shorter duration of surgery and fewer ORs may need the same or more transfer rooms than a hospital with longer duration of surgery and more ORs. However, with respect to an economic analysis, the costs and benefits of installing additional OR transfer rooms need to be calculated using the profit margins of the specific hospital.

"Sack Time" pencil drawing on north wall of sack room, ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

"Sack Time" pencil drawing on north wall of sack room, northeast corner, facing north. - Camp Tulelake, Shop-Storage Building, West Side of Hill Road, 2 miles South of State Highway 161, Tulelake, Siskiyou County, CA

Time-out Rooms in Residential Treatment Centers

ERIC Educational Resources Information Center

Endres, V. Joseph; Goke, Douglas H.

1973-01-01

Among professionals, the use of the time-out room for the control of disturbed children in residential centers evokes varied and sometimes opposing opinions. This study is based on a questionnaire submitted to 50 residential treatment centers. (Editor)

Improved Surgery Planning Using 3-D Printing: a Case Study.

PubMed

Singhal, A J; Shetty, V; Bhagavan, K R; Ragothaman, Ananthan; Shetty, V; Koneru, Ganesh; Agarwala, M

2016-04-01

The role of 3-D printing is presented for improved patient-specific surgery planning. Key benefits are time saved and surgery outcome. Two hard-tissue surgery models were 3-D printed, for orthopedic, pelvic surgery, and craniofacial surgery. We discuss software data conversion in computed tomography (CT)/magnetic resonance (MR) medical image for 3-D printing. 3-D printed models save time in surgery planning and help visualize complex pre-operative anatomy. Time saved in surgery planning can be as much as two thirds. In addition to improved surgery accuracy, 3-D printing presents opportunity in materials research. Other hard-tissue and soft-tissue cases in maxillofacial, abdominal, thoracic, cardiac, orthodontics, and neurosurgery are considered. We recommend using 3-D printing as standard protocol for surgery planning and for teaching surgery practices. A quick turnaround time of a 3-D printed surgery model, in improved accuracy in surgery planning, is helpful for the surgery team. It is recommended that these costs be within 20 % of the total surgery budget.