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

PubMed

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

2016-10-01

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

Endometrial cancer surgery costs: robot vs laparoscopy.

PubMed

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

2010-01-01

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

Cost of Surgery for Symptomatic Spinal Metastases in the United Kingdom.

PubMed

Turner, Isobel; Minhas, Zulfiqar; Kennedy, Joanne; Morris, Stephen; Crockard, Alan; Choi, David

2015-11-01

Spinal metastases represent a significant health and economic burden. The average cost of surgical management varies between institutions and countries, partially a result of differences in health care system billing. This study assessed hospital costs from a single institute in the United Kingdom National Healthcare Service and identified patient factors associated with these costs. This prospective study recruited patients with confirmed symptomatic spinal metastases who presented for surgical treatment. The primary outcome was cost of inpatient treatment collected using the Patient Level Costing and Information System; preoperative details collected included patient demographics, primary tumor type, Tomita and Tokuhashi scores, pain level, EuroQol 5 dimension score, Frankel, Karnofsky, and American Society of Anesthesiologists' physical status classification system scores, and operative details. Costs were analyzed for 74 patients. The mean cost of treatment (standard deviation, SD) per patient was £ 16,885 (£ 10,687); which was mainly comprised of operating theater (25% of the total) and ward costs (27%). Better health status at presentation significantly increased total and ward costs (Frankel score P = 0.006, and EuroQol 5 dimension index P = 0.014 respectively); male sex also increased total and ward costs (P < 0.01 and P = 0.06). Operation cost showed a trend to increased costs with less impairment on American Society of Anesthesiologists' physical status classification system scores. The cost of surgical management of spinal metastases is associated with several factors but is greater in patients presenting with better health status, probably because of their suitability for larger operations, whereas those with poor health status undergo smaller, palliative operations, resulting in shorter inpatient postoperative recovery. Copyright © 2015 Elsevier Inc. All rights reserved.

Space construction system analysis. Part 2: Cost and programmatics

NASA Technical Reports Server (NTRS)

Vonflue, F. W.; Cooper, W.

1980-01-01

Cost and programmatic elements of the space construction systems analysis study are discussed. The programmatic aspects of the ETVP program define a comprehensive plan for the development of a space platform, the construction system, and the space shuttle operations/logistics requirements. The cost analysis identified significant items of cost on ETVP development, ground, and flight segments, and detailed the items of space construction equipment and operations.

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

PubMed

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

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

Community Microgrid Scheduling Considering Network Operational Constraints and Building Thermal Dynamics

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

Liu, Guodong; Ollis, Thomas B.; Xiao, Bailu

Here, this paper proposes a Mixed Integer Conic Programming (MICP) model for community microgrids considering the network operational constraints and building thermal dynamics. The proposed optimization model optimizes not only the operating cost, including fuel cost, purchasing cost, battery degradation cost, voluntary load shedding cost and the cost associated with customer discomfort due to room temperature deviation from the set point, but also several performance indices, including voltage deviation, network power loss and power factor at the Point of Common Coupling (PCC). In particular, the detailed thermal dynamic model of buildings is integrated into the distribution optimal power flow (D-OPF)more » model for the optimal operation of community microgrids. The heating, ventilation and air-conditioning (HVAC) systems can be scheduled intelligently to reduce the electricity cost while maintaining the indoor temperature in the comfort range set by customers. Numerical simulation results show the effectiveness of the proposed model and significant saving in electricity cost could be achieved with network operational constraints satisfied.« less

Community Microgrid Scheduling Considering Network Operational Constraints and Building Thermal Dynamics

DOE PAGES

Liu, Guodong; Ollis, Thomas B.; Xiao, Bailu; ...

2017-10-10

Here, this paper proposes a Mixed Integer Conic Programming (MICP) model for community microgrids considering the network operational constraints and building thermal dynamics. The proposed optimization model optimizes not only the operating cost, including fuel cost, purchasing cost, battery degradation cost, voluntary load shedding cost and the cost associated with customer discomfort due to room temperature deviation from the set point, but also several performance indices, including voltage deviation, network power loss and power factor at the Point of Common Coupling (PCC). In particular, the detailed thermal dynamic model of buildings is integrated into the distribution optimal power flow (D-OPF)more » model for the optimal operation of community microgrids. The heating, ventilation and air-conditioning (HVAC) systems can be scheduled intelligently to reduce the electricity cost while maintaining the indoor temperature in the comfort range set by customers. Numerical simulation results show the effectiveness of the proposed model and significant saving in electricity cost could be achieved with network operational constraints satisfied.« less

The Cost of Deploying a Role 2 Medical Asset to Afghanistan.

PubMed

Childers, Richard; Parker, Paul

2015-11-01

The costs of military assets, including medical resources, are necessary for military planners when determining their force make up. The monetary cost of operating a Role 3 unit, the most comprehensive medical asset in the combat theater, has been determined. The cost of operating a Role 2 (R2) facility-the less comprehensive but more common asset-has not been assessed. Here we estimate the cost of operating an R2 medical asset in Afghanistan. Personnel costs were assessed by combining the U.S. Department of Defense estimate for personnel cost with the replacement costs for deployed staff. Manning was for a U.S. Marine Corps Shock Trauma Platoon and Forward Resuscitative Surgical System. It costs $2,956,873 a month to operate an R2 medical facility in Afghanistan. It also takes the place of a rifle platoon and disrupts the domestic military health care mission. The costs of operating an R2 medical facility are significant and should be considered when the medical benefits of an R2 are unclear. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

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

PubMed

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

2013-02-01

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

Lessons Learned for Planning and Estimating Operations Support Requirements

NASA Technical Reports Server (NTRS)

Newhouse, Marilyn

2011-01-01

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

Maxillomandibular Fixation by Plastic Surgeons: Cost Analysis and Utilization of Resources.

PubMed

Farber, Scott J; Snyder-Warwick, Alison K; Skolnick, Gary B; Woo, Albert S; Patel, Kamlesh B

2016-09-01

Maxillomandibular fixation (MMF) can be performed using various techniques. Two common approaches used are arch bars and bone screws. Arch bars are the gold standard and inexpensive, but often require increased procedure time. Bone screws with wire fixation is a popular alternative, but more expensive than arch bars. The differences in costs of care, complications, and operative times between these 2 techniques are analyzed. A chart review was conducted on patients treated over the last 12 years at our institution. Forty-four patients with CPT code 21453 (closed reduction of mandible fracture with interdental fixation) with an isolated mandible fracture were used in our data collection. The operating room (OR) costs, procedure duration, and complications for these patients were analyzed. Operative times were significantly shorter for patients treated with bone screws (P < 0.002). The costs for one trip to the OR for either method of fixation did not show any significant differences (P < 0.840). More patients with arch bar fixation (62%) required a second trip to the OR for removal in comparison to those with screw fixation (31%) (P < 0.068). This additional trip to the OR added significant cost. There were no differences in patient complications between these 2 fixation techniques. The MMF with bone screws represents an attractive alternative to fixation with arch bars in appropriate scenarios. Screw fixation offers reduced costs, fewer trips to the OR, and decreased operative duration without a difference in complications. Cost savings were noted most significantly in a decreased need for secondary procedures in patients who were treated with MMF screws. Screw fixation offers potential for reducing the costs of care in treating patients with minimally displaced or favorable mandible fractures.

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

PubMed Central

Chin, Garwin; Wright, David J.; Snir, Nimrod; Schwarzkopf, Ran

2018-01-01

Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P < .05) and greater in the following costs: hospital operating direct cost (29.2% greater), hospital operating total cost (28.8% greater), direct hospital cost (24.7% greater), and total hospital cost (26.4% greater). Conclusions Based on greater hospital operating direct cost, hospital operating total cost, direct hospital cost, and total hospital cost, conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA. PMID:26387923

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

PubMed

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

2012-12-01

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

Safety and cost-effectiveness analysis of laparoscopic splenectomy by secondary pedicle division using monopolar electrocautery.

PubMed

Zhou, Jianyin; Liu, Pingguo; Yin, Zhenyu; Zhao, Yilin; Wang, Xiaomin

2013-09-01

The expense of laparoscopic splenectomy (LS) has limited its use in developing countries, while medical costs are increasing worldwide. In this study, we performed LS by secondary pedicle division using monopolar electrocautery to achieve cost savings. Over seven years, we performed 45 consecutive LSs by secondary pedicle division using monopolar electrocautery (n=17) or ultrasonic shears (n=28) at a single center. These were reviewed to assess outcome and cost. Mean operating time was 179.7min, 7 conversions to open operation (15.6%) were necessary. There were four postoperative complications (8.9%) and no deaths. Twenty-three of 28 (82.1%) patients with idiopathic thrombocytopenic purpura developed a long-term positive response; and mean operative cost was RMB6,577 (US$1,034), which was much lower than that of Endo-GIATM in published reports. Between the monopolar electrocautery and ultrasonic shears groups, there were no significant differences in demographic characteristics or intraoperative and postoperative details, but operative cost was significantly lower in the former (RMB4,416, US$696 vs. RMB7,889, US$1,243; p<0.01). LS by secondary pedicle division using monopolar electrocautery is safe, efficacious and economical.

Recent Enhancements to the National Transonic Facility (Mixed Mode Operations)

NASA Technical Reports Server (NTRS)

Kilgore, W. Allen; Chan, David; Balakrishna, S.; Wahls, Richard A.

2006-01-01

The U.S. National Transonic Facility continues to make enhancements to provide quality data in a safe, efficient and cost effective method for aerodynamic ground testing. Recent enhancements discussed in this paper include the development of a Mixed-mode of operations that combine Air-mode operations with Nitrogen-mode operations. This implementation and operational results of this new Mixed-mode expands the ambient temperature transonic region of testing beyond the Air-mode limitations at a significantly reduced cost over Nitrogen Mode operation.

Optimization of power systems with voltage security constraints

NASA Astrophysics Data System (ADS)

Rosehart, William Daniel

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

Study of Advanced Propulsion Systems for Small Transport Aircraft Technology (STAT) Program

NASA Technical Reports Server (NTRS)

Baerst, C. F.; Heldenbrand, R. W.; Rowse, J. H.

1981-01-01

Definitions of takeoff gross weight, performance, and direct operating cost for both a 30 and 50 passenger airplane were established. The results indicate that a potential direct operating cost benefit, resulting from advanced technologies, of approximately 20 percent would be achieved for the 1990 engines. Of the numerous design features that were evaluated, only maintenance-related items contributed to a significant decrease in direct operating cost. Recommendations are made to continue research and technology programs for advanced component and engine development.

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

PubMed

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

2014-02-01

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

[Cost and Revenue Relationship in Orthopaedic and Trauma Surgery Patients in Relation to Body Mass Index].

PubMed

Schmelz, Helmut A; Geraedts, Max

2018-06-14

Growing numbers of patients in orthopaedic and trauma surgery are obese. The risks involved are e.g. surgical complications, higher costs for longer hospital stays or special operating tables. It is a moot point whether revenues in the German DRG system cover the individual costs in relation to patients' body mass index (BMI) and in which area of hospital care potentially higher costs occur. Data related to BMI, individual costs and revenues were extracted from the hospital information system for 13,833 patients of a large hospital who were operated in 2007 to 2010 on their upper or lower extremities. We analysed differences in cost revenue relations dependent on patients' BMI and surgical site, and differences in the distribution of hospital cost areas in relation to patients' BMI by t and U tests. Individual costs of morbidly obese (BMI ≥ 40) and underweight patients (BMI < 18.5) significantly (p < 0.05) exceeded individual DRG revenues. Significantly higher cost revenue relations were detected for all operations on the lower and upper extremities except for ankle joint surgeries in which arthroscopical procedures predominate. Most of the incremental costs resulted from higher spending for nursing care, medication and special appliances. Costs for doctors and medical ancillary staff did not increase in relation to patients' BMI. To avoid BMI related patient discrimination, supplementary fees to cover extra costs for morbidly obese or underweight patients with upper or lower extremities operations should raise DRG revenues. Moreover, hospitals should be organisationally prepared for these patients. Georg Thieme Verlag KG Stuttgart · New York.

Physician Education on Controllable Costs Significantly Reduces Cost of Laparoscopic Hysterectomy.

PubMed

Croft, Katherine; Mattingly, Patricia J; Bosse, Patrick; Naumann, R Wendel

2017-01-01

To determine whether educating surgeons about their controllable instrumentation costs by providing cost data on total laparoscopic hysterectomy (LH) would reduce the cost of this procedure. Prospective cohort study (Canadian Task Force classification III). Academic-affiliated community hospital. Patients who underwent LH between April 2014 and March 2015 with surgeons who performed at least 10 LHs during that time period, along with a second group who underwent LH with the same cohort of surgeons between July 2015 and September 2015. The cost of LH was calculated for all surgeons who performed more than 10 LHs between April 2014 and March 2015. Itemized cost data were collected. The individual costs, as well as a summary of the data, were shared with all of the physicians to highlight areas of potential cost savings. The costs were then measured for 3 months after the educational intervention (July-September 2015) to gauge the impact of physician cost education. Thirteen surgeons met the criteria for inclusion in this analysis. Together, they performed 271 hysterectomies, with an average instrumentation cost of $1539.47 ± $294.16 and an average operating room time of 178 ± 26 minutes. Bipolar instrument choice represented 37% of the baseline costs, followed by 10% for trocar, 9% for cuff closure, and 8% for uterine manipulator. This same group of surgeons performed a total of 69 hysterectomies in the 3-month follow-up period of July-September 2015, with an average instrumentation cost of $1282.62 ± $235.03 and an average operating room time of 163 ± 50 minutes. There was statistically significant cost reduction of $256.85 ± $190.69 (p = .022), with no significant change in operating room time. Bipolar instrument cost decreased significantly, by $130.02 ± $125.02 (p = .021), representing 51% of the total cost savings. Trocar, cuff closure, and uterine manipulator costs were not significant sources of cost savings on average, but did represent sources of cost savings for some surgeons individually. Given adequate education about the products available for use in their institution, surgeons make informed decisions regarding the choice of instrumentation, allowing them to directly impact the cost of total LH, resulting in cost savings. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Costs and benefits of different methods of esophagectomy for esophageal cancer.

PubMed

Yanasoot, Alongkorn; Yolsuriyanwong, Kamtorn; Ruangsin, Sakchai; Laohawiriyakamol, Supparerk; Sunpaweravong, Somkiat

2017-01-01

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown's esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

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

PubMed

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

2013-06-01

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

Transit operator absenteeism.

DOT National Transportation Integrated Search

1985-01-01

A nationwide survey of transit operators indicated that absenteeism among transit operators is a significant problem and that the associated costs are substantial. The objective of the research reported here was to determine the scope of operator abs...

Some Conditions for Cost Efficiency in Hypermedia.

ERIC Educational Resources Information Center

Westland, J. Christopher

1998-01-01

Models administrative and operating costs surrounding a hypermedia database and identifies seven conditions for the cost justification of hypermedia. Concludes that cost considerations aside, hypermedia offers significant data retrieval benefits in accessing text, video, still pictures, and sound, and provides substantially better human…

Analysis of Anterior Cervical Discectomy and Fusion Healthcare Costs via the Value-Driven Outcomes Tool.

PubMed

Reese, Jared C; Karsy, Michael; Twitchell, Spencer; Bisson, Erica F

2018-04-11

Examining the costs of single- and multilevel anterior cervical discectomy and fusion (ACDF) is important for the identification of cost drivers and potentially reducing patient costs. A novel tool at our institution provides direct costs for the identification of potential drivers. To assess perioperative healthcare costs for patients undergoing an ACDF. Patients who underwent an elective ACDF between July 2011 and January 2017 were identified retrospectively. Factors adding to total cost were placed into subcategories to identify the most significant contributors, and potential drivers of total cost were evaluated using a multivariable linear regression model. A total of 465 patients (mean, age 53 ± 12 yr, 54% male) met the inclusion criteria for this study. The distribution of total cost was broken down into supplies/implants (39%), facility utilization (37%), physician fees (14%), pharmacy (7%), imaging (2%), and laboratory studies (1%). A multivariable linear regression analysis showed that total cost was significantly affected by the number of levels operated on, operating room time, and length of stay. Costs also showed a narrow distribution with few outliers and did not vary significantly over time. These results suggest that facility utilization and supplies/implants are the predominant cost contributors, accounting for 76% of the total cost of ACDF procedures. Efforts at lowering costs within these categories should make the most impact on providing more cost-effective care.

Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects

PubMed Central

O’Byrne, Michael L.; Gillespie, Matthew J.; Shinohara, Russell T.; Dori, Yoav; Rome, Jonathan J.; Glatz, Andrew C.

2015-01-01

Background Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described. Methods A single-center retrospective cohort study of children and adults <30 years of age undergoing closure for single secundum ASD from January 1, 2007, to April 1, 2012, was performed to measure differences in inflation-adjusted cost of operative and transcatheter closures of ASD. A propensity score weight-adjusted multivariate regression model was used in an intention-to-treat analysis. Costs for reintervention and crossover admissions were included in primary analysis. Results A total of 244 subjects were included in the study (64% transcatheter and 36% operative), of which 2% (n = 5) were ≥18 years. Crossover rate from transcatheter to operative group was 3%. Risk of reintervention (P = .66) and 30-day mortality (P = .37) were not significantly different. In a multivariate model, adjusted cost of operative closure was 2012 US $60,992 versus 2012 US $55,841 for transcatheter closure (P < .001). Components of total cost favoring transcatheter closure were length of stay, medications, and follow-up radiologic and laboratory testing, overcoming higher costs of procedure and echocardiography. Professional costs did not differ. The rate of 30-day readmission was greater in the operative cohort, further increasing the cost advantage of transcatheter closure. Sensitivity analyses demonstrated that costs of follow-up visits influenced relative cost but that device closure remained favorable over a broad range of crossover and reintervention rates. Conclusion For single secundum ASD, cost comparison analysis favors transcatheter closure over the short term. The cost of follow-up regimens influences the cost advantage of transcatheter closure. PMID:25965721

An operations concept methodology to achieve low-cost mission operations

NASA Technical Reports Server (NTRS)

Ledbetter, Kenneth W.; Wall, Stephen D.

1993-01-01

Historically, the Mission Operations System (MOS) for a space mission has been designed last because it is needed last. This has usually meant that the ground system must adjust to the flight vehicle design, sometimes at a significant cost. As newer missions have increasingly longer flight operations lifetimes, the MOS becomes proportionally more difficult and more resource-consuming. We can no longer afford to design the MOS last. The MOS concept may well drive the spacecraft, instrument, and mission designs, as well as the ground system. A method to help avoid these difficulties, responding to the changing nature of mission operations is presented. Proper development and use of an Operations Concept document results in a combined flight and ground system design yielding enhanced operability and producing increased flexibility for less cost.

Costs of Robotic-Assisted Versus Traditional Laparoscopy in Endometrial Cancer.

PubMed

Vuorinen, Riikka-Liisa K; Mäenpää, Minna M; Nieminen, Kari; Tomás, Eija I; Luukkaala, Tiina H; Auvinen, Anssi; Mäenpää, Johanna U

2017-10-01

The purpose of this study was to compare the costs of traditional laparoscopy and robotic-assisted laparoscopy in the treatment of endometrial cancer. A total of 101 patients with endometrial cancer were randomized to the study and operated on starting from 2010 until 2013, at the Department of Obstetrics and Gynecology of Tampere University Hospital, Tampere, Finland. Costs were calculated based on internal accounting, hospital database, and purchase prices and were compared using intention-to-treat analysis. Main outcome measures were item costs and total costs related to the operation, including a 6-month postoperative follow-up. The total costs including late complications were 2160 &OV0556; higher in the robotic group (median for traditional 5823 &OV0556;, vs robot median 7983 &OV0556;, P < 0.001). The difference was due to higher costs for instruments and equipment as well as to more expensive operating room and postanesthesia care unit time. Traditional laparoscopy involved higher costs for operation personnel, general costs, medication used in the operation, and surgeon, although these costs were not substantial. There was no significant difference in in-patient stay, laboratory, radiology, blood products, or costs related to complications. According to this study, robotic-assisted laparoscopy is 37% more expensive than traditional laparoscopy in the treatment of endometrial cancer. The cost difference is mainly explained by amortization of the robot and its instrumentation.

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.

Toward lowering the cost of mission operations

NASA Technical Reports Server (NTRS)

Wall, S. D.; Ledbetter, K. W.

1993-01-01

The mission operations system is one of the more significant drivers of the cost of the mission operations and data analysis segment of missions. In large or long-lived projects, the MOS can also be a driver in total mission cost. Larger numbers of missions, together with an increasingly cost-conscious environment, dictate that future missions must more strictly control costs as they perform to their requirements. It is therefore prudent to examine the conduct of past missions for ways to conserve resources. In this paper we review inputs made to past projects' 'lessons-learned' activities, in which personnel from past projects (among other things) identified major cost drivers of MOS's and considered how economies were or might have been realized in both design and performance of their MOS. Common themes among four such reviews are summarized in an attempt to provide suggestions for cost reduction in future missions.

Interpreting cost of ownership for mix-and-match lithography

NASA Astrophysics Data System (ADS)

Levine, Alan L.; Bergendahl, Albert S.

1994-05-01

Cost of ownership modeling is a critical and emerging tool that provides significant insight into the ways to optimize device manufacturing costs. The development of a model to deal with a particular application, mix-and-match lithography, was performed in order to determine the level of cost savings and the optimum ways to create these savings. The use of sensitivity analysis with cost of ownership allows the user to make accurate trade-offs between technology and cost. The use and interpretation of the model results are described in this paper. Parameters analyzed include several manufacturing considerations -- depreciation, maintenance, engineering and operator labor, floorspace, resist, consumables and reticles. Inherent in this study is the ability to customize this analysis for a particular operating environment. Results demonstrate the clear advantages of a mix-and-match approach for three different operating environments. These case studies also demonstrate various methods to efficiently optimize cost savings strategies.

Tubing vs. buckets: a cost comparison

Treesearch

Neil K. Huyler

1975-01-01

Equipment investment for tubing-vacuum systems was significantly less than that for bucket systems. Tubing-vacuum systems required about 22 percent less labor input, the major labor input being completed before sap-flow periods. Annual cost of operation was less for tubing-vacuum than the bucket system. Small tubing-vacuum operations showed more profit potential than...

Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study.

PubMed

Luckraz, Heyman; Manga, Na'ngono; Senanayake, Eshan L; Abdelaziz, Mahmoud; Gopal, Shameer; Charman, Susan C; Giri, Ramesh; Oppong, Raymond; Andronis, Lazaros

2018-05-01

Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom. Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416). Patients who were diagnosed as developing ventilator-associated pneumonia, as per the surveillance definition for ventilator-associated pneumonia (n = 338), were propensity score matched with those who did not (n = 338). Costs of treating post-op cardiac surgery patients in intensive care and cost difference if ventilator-associated pneumonia occurred based on Healthcare Resource Group categories were assessed. Secondary outcomes included differences in morbidity, mortality and cardiac intensive care unit and in-hospital length of stay. There were no significant differences in the pre-operative characteristics or procedures between the groups. Ventilator-associated pneumonia developed in 10% of post-cardiac surgery patients. Post-operatively, the ventilator-associated pneumonia group required longer ventilation (p < 0.01), more respiratory support, longer cardiac intensive care unit (8 vs 3, p < 0.001) and in-hospital stay (16 vs 9) days. The overall cost for post-operative recovery after cardiac surgery for ventilator-associated pneumonia patients was £15,124 compared to £6295 for non-ventilator-associated pneumonia (p < 0.01). The additional cost of treating patients with ventilator-associated pneumonia was £8829. Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.

New Ways Of Doing Business (NWODB) cost quantification analysis

NASA Technical Reports Server (NTRS)

Hamaker, Joseph W.; Rosmait, Russell L.

1992-01-01

The cost of designing, producing, and operating typical aerospace flight hardware is necessarily more expensive than most other human endeavors. Because of the more stringent environment of space, hardware designed to operate there will probably always be more expensive than similar hardware which is designed for less taxing environments. It is the thesis of this study that there are very significant improvements that can be made in the cost of aerospace flight hardware.

Operative outcome and hospital cost.

PubMed

Ferraris, V A; Ferraris, S P; Singh, A

1998-03-01

Because of concern about increasing health care costs, we undertook a study to find patient risk factors associated with increased hospital costs and to evaluate the relationship between increased cost and in-hospital mortality and serious morbidity. More than 100 patient variables were screened in 1221 patients undergoing cardiac procedures. Simultaneously, patient hospital costs were computed from the cost-to-charge ratio. Univariate and multivariate statistics were used to explore the relationship between hospital cost and patient outcomes, including operative death, in-hospital morbidity, and length of stay. The greatest costs were for 31 patients who did not survive operation ($74,466, 95% confidence interval $27,102 to $198,025), greater than the costs for 120 patients who had serious, nonfatal morbidity ($60,335, 95% confidence interval $28,381 to $130,897, p = 0.02) and those for 1070 patients who survived operation without complication ($31,459, 95% confidence interval $21,944 to $49,849, p = 0.001). Breakdown of the components of hospital costs in fatalities and in cases with nonfatal complications revealed that the greatest contributions were in anesthesia and operating room costs. Significant (by stepwise linear regression analysis) independent risks for increased hospital cost were as follows (in order of decreasing importance): (1) preoperative congestive heart failure, (2) serum creatinine level greater than 2.5 mg/dl, (3) New York state predicted mortality risk, (4), type of operation (coronary artery bypass grafting, valve, valve plus coronary artery bypass grafting, or other), (5) preoperative hematocrit, (6) need for reoperative procedure, (7) operative priority, and (8) sex. These risks were different than those for in-hospitality death or increased length of stay. Hospital cost correlated with length of stay (r = 0.63, p < 0.001), but there were many outliers at the high end of the hospital cost spectrum. We conclude that operative death is the most costly outcome; length of stay is an unreliable indicator of hospital cost, especially at the high end of the cost spectrum; risks of increased hospital cost are different than those for perioperative mortality or increased length of stay; and ventricular dysfunction in elderly patients undergoing urgent operations for other than coronary disease is associated with increased cost. Certain patient factors, such as preoperative anemia and congestive heart failure, are amenable to preoperative intervention to reduce costs, and a high-risk patient profile can serve as a target for cost-reduction strategies.

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

NASA Astrophysics Data System (ADS)

Petrakopoulou, F.; Santana, D.

2016-12-01

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

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

PubMed

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

2008-01-01

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

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

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

Voelker, Gary; Arnold, John

2015-11-30

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

A comprehensive methodology for intelligent systems life-cycle cost modelling

NASA Technical Reports Server (NTRS)

Korsmeyer, David J.; Lum, Henry, Jr.

1993-01-01

As NASA moves into the last part on the twentieth century, the desire to do 'business as usual' has been replaced with the mantra 'faster, cheaper, better'. Recently, new work has been done to show how the implementation of advanced technologies, such as intelligent systems, will impact the cost of a system design or in the operational cost for a spacecraft mission. The impact of the degree of autonomous or intelligent systems and human participation on a given program is manifested most significantly during the program operational phases, while the decision of who performs what tasks, and how much automation is incorporated into the system are all made during the design and development phases. Employing intelligent systems and automation is not an either/or question, but one of degree. The question is what level of automation and autonomy will provide the optimal trade-off between performance and cost. Conventional costing methodologies, however, are unable to show the significance of technologies like these in terms of traceable cost benefits and reductions in the various phases of the spacecraft's lifecycle. The proposed comprehensive life-cycle methodology can address intelligent system technologies as well as others that impact human-machine operational modes.

Solar Market Research and Analysis Projects | Solar Research | NREL

Science.gov Websites

increase the effectiveness and reduce the variability and cost of PV operations and maintenance (O&M significantly drive up the cost of electricity for PV systems. To help reduce PV O&M costs and improve PV -Storage: Reducing Barriers Through Cost-Optimization and Market Characterization While falling costs have

EOS MLS Lessons Learned: Design Ideas for Safer and Lower Cost Operations

NASA Technical Reports Server (NTRS)

Miller, Dominick

2012-01-01

The Earth Observing System (EOS) Microwave Limb Sounder (MLS) is a complex instrument with a front end computer and 32 subsystem computers. MLS is one of four instruments on NASA's EOS Aura spacecraft With almost 8 years in orbit, MLS has a few lessons learned which can be applied during the design phase of future instruments to effect better longevity, more robust operations and a significant cost benefit during operations phase.

Contrast in low-cost operational concepts for orbiting satellites

NASA Astrophysics Data System (ADS)

Walyus, Keith D.; Reis, James; Bradley, Arthur J.

2002-12-01

Older spacecraft missions, especially those in low Earth orbit with telemetry intensive requirements, required round-the-clock control center staffing. The state of technology relied on control center personnel to continually examine data, make decisions, resolve anomalies, and file reports. Hubble Space Telescope (HST) is a prime example of this description. Technological advancements in hardware and software over the last decade have yielded increases in productivity and operational efficiency, which result in lower cost. The re-engineering effort of HST, which has recently concluded, utilized emerging technology to reduce cost and increase productivity. New missions, of which NASA's Transition Region and Coronal Explorer Satellite (TRACE) is an example, have benefited from recent technological advancements and are more cost-effective than when HST was first launched. During its launch (1998) and early orbit phase, the TRACE Flight Operations Team (FOT) employed continually staffed operations. Yet once the mission entered its nominal phase, the FOT reduced their staffing to standard weekday business hours. Operations were still conducted at night and during the weekends, but these operations occurred autonomously without compromising their high standards for data collections. For the HST, which launched in 1990, reduced cost operations will employ a different operational concept, when the spacecraft enters its low-cost phase after its final servicing mission in 2004. Primarily due to the spacecraft"s design, the HST Project has determined that single-shift operations will introduce unacceptable risks for the amount of dollars saved. More importantly, significant cost-savings can still be achieved by changing the operational concept for the FOT, while still maintaining round-the-clock staffing. It"s important to note that the low-cost solutions obtained for one satellite may not be applicable for other satellites. This paper will contrast the differences between low-cost operational concepts for a satellite launched in 1998 versus a satellite launched in 1990.

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

NASA Technical Reports Server (NTRS)

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

1992-01-01

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

The relationships between OHS prevention costs, safety performance, employee satisfaction and accident costs.

PubMed

Bayram, Metin; Ünğan, Mustafa C; Ardıç, Kadir

2017-06-01

Little is known about the costs of safety. A literature review conducted for this study indicates there is a lack of survey-based research dealing with the effects of occupational health and safety (OHS) prevention costs. To close this gap in the literature, this study investigates the interwoven relationships between OHS prevention costs, employee satisfaction, OHS performance and accident costs. Data were collected from 159 OHS management system 18001-certified firms operating in Turkey and analyzed through structural equation modeling. The findings indicate that OHS prevention costs have a significant positive effect on safety performance, employee satisfaction and accident costs savings; employee satisfaction has a significant positive effect on accident costs savings; and occupational safety performance has a significant positive effect on employee satisfaction and accident costs savings. Also, the results indicate that safety performance and employee satisfaction leverage the relationship between prevention costs and accident costs.

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.

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

PubMed Central

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

2014-01-01

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

The comparative economic performance of investor-owned chain and not-for-profit hospitals.

PubMed

Watt, J M; Derzon, R A; Renn, S C; Schramm, C J; Hahn, J S; Pillari, G D

1986-01-09

We examined the differences in the economic performance of 80 matched pairs of investor-owned chain and not-for-profit hospitals in eight states during 1978 and 1980, and considered how their operating strategies might affect their relative success in a more price-conscious market. We found that total charges (adjusted for case mix) and net revenues per case were both significantly higher in the investor-owned chain hospitals, mainly because of higher charges for ancillary services; there were no significant differences between the two groups of hospitals in regard to patient-care costs per case (adjusted for case mix), but the investor-owned hospitals had significantly higher administrative overhead costs; investor-owned hospitals were more profitable; investor-owned hospitals had fewer employees per occupied bed but paid more per employee; investor-owned hospitals had funded more of their capital through debt and had significantly higher capital costs in proportion to their operating costs; and the two groups did not differ in patient mix, as measured by their Medicare case-mix indexes or the proportions of their patients covered by Medicare or Medicaid. We conclude that investor-owned chain hospitals generated higher profits through more aggressive pricing practices rather than operating efficiencies - a result not unexpected in view of past cost-based reimbursement policies. Recent changes in these policies are creating new pressures for cost control and moderation in charges, to which both types of hospitals must adapt. Neither type has a clear-cut advantage in the ability to make the necessary changes.

Two-Way Satellite Time and Frequency Transfer Using 1 MChips/s Codes

DTIC Science & Technology

2009-11-01

Abstract The Ku-band transatlantic and Europe-to-Europe two-way satellite time and frequency transfer ( TWSTFT ) operations used 2.5 MChip/s...pseudo-random codes with 3.5 MHz bandwidth until the end of July 2009. The cost of TWSTFT operation is associated with the bandwidth used on a...geostationary satellite. The transatlantic and Europe-to-Europe TWSTFT operations faced a significant increase in cost for using 3.5 MHz bandwidth on a new

Logistics Aloft

DTIC Science & Technology

2011-02-17

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

Analysis on logistic company action toward the access restriction policy on freight vehicle

NASA Astrophysics Data System (ADS)

Nur, Muhammad; Hadiwardoyo, Sigit P.; Nahry, Nahdalina

2017-06-01

The high volume of freight vehicles that enters, leaves or passes through the urban areas, especially Jakarta, has caused traffic congestion. Local authority plans to perform the access restriction on freight vehicles on the Jakarta Outer Ring Road (JORR) to reduce the congestion on that toll road. The study aims to analyze the alternative solutions of the logistics companies to overcome the impact of such policy. The data collection is done by interviewing 102 truck drivers and 7 staffs of logistic companies that use JORR. The results show that the most preferred action is shifting the operating time. Based on the open test, access restriction policy on JORR may cause a significant impact on the operational costs of delivery. Shifting the operational time will increase the operating cost by 1.71%, while turning the route will increase the operating costs by 4.35%. Moreover, changing the mode will reduce the operating expenses by 50%, and the combination action of shifting the route and the time will increase the operating costs by 5.39%.

Cost-benefit analysis of different air change rates in an operating room environment.

PubMed

Gormley, Thomas; Markel, Troy A; Jones, Howard; Greeley, Damon; Ostojic, John; Clarke, James H; Abkowitz, Mark; Wagner, Jennifer

2017-12-01

Hospitals face growing pressure to meet the dual but often competing goals of providing a safe environment while controlling operating costs. Evidence-based data are needed to provide insight for facility management practices to support these goals. The quality of the air in 3 operating rooms was measured at different ventilation rates. The energy cost to provide the heating, ventilation, and air conditioning to the rooms was estimated to provide a cost-benefit comparison of the effectiveness of different ventilation rates currently used in the health care industry. Simply increasing air change rates in the operating rooms tested did not necessarily provide an overall cleaner environment, but did substantially increase energy consumption and costs. Additionally, and unexpectedly, significant differences in microbial load and air velocity were detected between the sterile fields and back instrument tables. Increasing the ventilation rates in operating rooms in an effort to improve clinical outcomes and potentially reduce surgical site infections does not necessarily provide cleaner air, but does typically increase operating costs. Efficient distribution or management of the air can improve quality indicators and potentially reduce the number of air changes required. Measurable environmental quality indicators could be used in lieu of or in addition to air change rate requirements to optimize cost and quality for an operating room and other critical environments. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The cost of conversion in robotic and laparoscopic colorectal surgery.

PubMed

Cleary, Robert K; Mullard, Andrew J; Ferraro, Jane; Regenbogen, Scott E

2018-03-01

Conversion from minimally invasive to open colorectal surgery remains common and costly. Robotic colorectal surgery is associated with lower rates of conversion than laparoscopy, but institutions and payers remain concerned about equipment and implementation costs. Recognizing that reimbursement reform and bundled payments expand perspectives on cost to include the entire surgical episode, we evaluated the role of minimally invasive conversion in total payments. This is an observational study from a linked data registry including clinical data from the Michigan Surgical Quality Collaborative and payment data from the Michigan Value Collaborative between July 2012 and April 2015. We evaluated colorectal resections initiated with open and minimally invasive approaches, and compared reported risk-adjusted and price-standardized 30-day episode payments and their components. We identified 1061 open, 1604 laparoscopic, and 275 robotic colorectal resections. Adjusted episode payments were significantly higher for open operations than for minimally invasive procedures completed without conversion ($19,489 vs. $15,518, p < 0.001). The conversion rate was significantly higher with laparoscopic than robotic operations (15.1 vs. 7.6%, p < 0.001). Adjusted episode payments for minimally invasive operations converted to open were significantly higher than for those completed by minimally invasive approaches ($18,098 vs. $15,518, p < 0.001). Payments for operations completed robotically were greater than those completed laparoscopically ($16,949 vs. $15,250, p < 0.001), but the difference was substantially decreased when conversion to open cases was included ($16,939 vs. $15,699, p = 0.041). Episode payments for open colorectal surgery exceed both laparoscopic and robotic minimally invasive options. Conversion to open surgery significantly increases the payments associated with minimally invasive colorectal surgery. Because conversion rates in robotic colorectal operations are half of those in laparoscopy, the excess expenditures attributable to robotics are attenuated by consideration of the cost of conversions.

Hospital costs of complications after a pancreatoduodenectomy

PubMed Central

Santema, Trientje B; Visser, Annelies; Busch, Olivier R C; Dijkgraaf, Marcel G W; Goslings, J Carel; Gouma, D J; Ubbink, Dirk T

2015-01-01

Background A pancreatoduodenectomy (PD) is a highly advanced procedure associated with considerable post-operative complications and substantial costs. In this study the hospital costs associated with complications after PD were assessed. Methods A retrospective cohort study was conducted on 100 consecutive patients who underwent a pylorus-preserving (PP)PD between January 2012 and July 2013. Per patient, all complications occurring during admission or in the 30-day period after discharge were documented. All hospital costs related to the (PP)PD were defined as the costs of all medical interventions and resources during the hospitalisation period as recorded by the electronic supply tracking system. Results The median hospital costs ranged from €17 482 for a patient without complications to €55 623 for a patient with a post-operative haemorrhage. A post-operative haemorrhage was associated with a 39.6% increase in total hospital costs after adjusting for patient characteristics. Other factors significantly associated with an increase in total hospital costs were: the presence of a malignancy other than a pancreatic adenocarcinoma (29.4% cost increase), the severity grade of a complication (34.3–70.6% increase) and the presence of a post-operative infection (32.4% increase). Conclusions This study provides an in-depth analysis of hospital costs and identifies factors that are associated with substantial cost consequences of specific complications occurring after a PD. PMID:26082095

40 CFR 35.2035 - Rotating biological contractor (RBC) replacement grants.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works... a grant for 100 percent of the cost, including planning and design costs, of modification or...) The RBC failure has significantly increased the project's capital or operation and maintenance costs...

40 CFR 35.2035 - Rotating biological contractor (RBC) replacement grants.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works... a grant for 100 percent of the cost, including planning and design costs, of modification or...) The RBC failure has significantly increased the project's capital or operation and maintenance costs...

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

PubMed

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

2016-11-01

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

Cost-effectiveness analysis of repeat fine-needle aspiration for thyroid biopsies read as atypia of undetermined significance.

PubMed

Heller, Michael; Zanocco, Kyle; Zydowicz, Sara; Elaraj, Dina; Nayar, Ritu; Sturgeon, Cord

2012-09-01

The 2007 National Cancer Institute (NCI) conference on Thyroid Fine-Needle Aspiration (FNA) introduced the category atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS). Repeat FNA in 3 to 6 months was recommended for low-risk patients. Compliance with these recommendations has been suboptimal. We hypothesized that repeat FNA would be more effective than diagnostic lobectomy, with decreased costs and improved rates of cancer detection. Cost-effectiveness analysis was performed in which we compared diagnostic lobectomy with repeat FNA. A Markov model was developed. Outcomes and probabilities were identified from literature review. Third-party payer costs were estimated in 2010 US dollars. Outcomes were weighted by use of the quality-of-life utility factors, yielding quality-adjusted life years (QALYs). Monte Carlo simulation and sensitivity analysis were used to examine the uncertainty of probability, cost, and utility estimates. The diagnostic lobectomy strategy cost $8,057 and produced 23.99 QALYs. Repeat FNA cost $2,462 and produced 24.05 QALYs. Repeat FNA was dominant until the cost of FNA increased to $6,091. Dominance of the repeat FNA strategy was not sensitive to the cost of operation or the complication rate. The NCI recommendations for repeat FNA regarding follow-up of AUS/FLUS results are cost-effective. Improving compliance with these guidelines should lead to less overall costs, greater quality of life, and fewer unnecessary operations. Copyright © 2012 Mosby, Inc. All rights reserved.

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

PubMed

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

2017-07-01

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

Reduced length of stay in hospital for burn patients following a change in practice guidelines: financial implications.

PubMed

Jansen, Leigh A; Hynes, Sally L; Macadam, Sheina A; Papp, Anthony

2012-01-01

The objective of this study was to analyze the financial implications of the implementation of new institutional practice guidelines including greater outpatient care and earlier operative intervention in a provincial burn center. A retrospective review was performed including all patients admitted to the Burn Unit with burns up to 20% TBSA between August 2005 and July 2009, including 2 years before and after the new guidelines were introduced. Daily costs for the burn unit were used to calculate this portion of cost. Length of stay (LOS) was based on actual data and representative clinical scenarios. Two hundred sixty-four patients were included. Mean LOS decreased from 10.3 to 3.9 (P < .01) and 21.0 to 13.3 (P > .05) for nonoperative burns 0 to 10% and 10 to 20% TBSA, respectively. Mean LOS for operative burns decreased from 16.6 to 12.9 and 32.3 to 29.8 days for 0 to 10% and 10 to 20% TBSA, respectively (P > .05). Burn patient management requires significant financial resources, and LOS has a large impact on cost. Given per diem rates of Can$1,663, scenario analysis shows potential cost savings of Can$19,956 per patient for operative and nonoperative burns <20% TBSA. With an average of 66 such patients treated each year, potential annual cost savings are Can$1.3 million. If outcomes are not compromised, earlier operative management and greater outpatient care can translate into significant cost savings. A prospective analysis capturing all costs and patient quality of life is required for further assessment.

Incorporating robotic-assisted surgery for endometrial cancer staging: Analysis of morbidity and costs.

PubMed

Bogani, Giorgio; Multinu, Francesco; Dowdy, Sean C; Cliby, William A; Wilson, Timothy O; Gostout, Bobbie S; Weaver, Amy L; Borah, Bijan J; Killian, Jill M; Bijlani, Akash; Angioni, Stefano; Mariani, Andrea

2016-05-01

To evaluate how the introduction of robotic-assisted surgery affects treatment-related morbidity and cost of endometrial cancer (EC) staging. We retrospectively reviewed the records of consecutive patients with stage I-III EC undergoing surgical staging between 2007 and 2012 at our institution. Costs (from surgery to 30days after surgery) were set based on the Medicare cost-to-charge ratio for each year and inflated to 2014 values. Inverse probability weighting (IPW) was used to decrease the allocation bias when comparing outcomes between surgical groups. We focused our analysis on the 251 EC patients who had robotic-assisted surgery and the 384 who had open staging. During the study period, the use of robotic-assisted surgery increased and open staging decreased (P<0.001). Correcting group imbalances by using IPW methodology, we observed that patients undergoing robotic-assisted staging had a significantly lower postoperative complication rate, lower blood transfusion rate, longer median operating time, shorter median length of stay, and lower readmission rate than patients undergoing open staging (all P<0.001). Overall 30-day costs were similar between the 2 groups, with robotic-assisted surgery having significantly higher median operating room costs ($2820 difference; P<0.001) but lower median room and board costs ($2929 difference; P<0.001) than open surgery. Increasing experience with robotic-assisted staging was significantly associated with a decrease in median operating time (P=0.002) and length of stay (P=0.003). The implementation of robotic-assisted surgery for EC staging improves patient outcomes. It provides women the benefits of minimally invasive surgery without increasing costs and potentially improves patient turnover. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2014-04-01

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

Specialty hospitals emulating focused factories: a case study.

PubMed

Kumar, Sameer

2010-01-01

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

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

PubMed

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

2017-11-01

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

On real-space Density Functional Theory for non-orthogonal crystal systems: Kronecker product formulation of the kinetic energy operator

NASA Astrophysics Data System (ADS)

Sharma, Abhiraj; Suryanarayana, Phanish

2018-05-01

We present an accurate and efficient real-space Density Functional Theory (DFT) framework for the ab initio study of non-orthogonal crystal systems. Specifically, employing a local reformulation of the electrostatics, we develop a novel Kronecker product formulation of the real-space kinetic energy operator that significantly reduces the number of operations associated with the Laplacian-vector multiplication, the dominant cost in practical computations. In particular, we reduce the scaling with respect to finite-difference order from quadratic to linear, thereby significantly bridging the gap in computational cost between non-orthogonal and orthogonal systems. We verify the accuracy and efficiency of the proposed methodology through selected examples.

Modeling Imperfect Generator Behavior in Power System Operation Models

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

Krad, Ibrahim

A key component in power system operations is the use of computer models to quickly study and analyze different operating conditions and futures in an efficient manner. The output of these models are sensitive to the data used in them as well as the assumptions made during their execution. One typical assumption is that generators and load assets perfectly follow operator control signals. While this is a valid simulation assumption, generators may not always accurately follow control signals. This imperfect response of generators could impact cost and reliability metrics. This paper proposes a generator model that capture this imperfect behaviormore » and examines its impact on production costs and reliability metrics using a steady-state power system operations model. Preliminary analysis shows that while costs remain relatively unchanged, there could be significant impacts on reliability metrics.« less

Water Distribution System Operation and Maintenance. A Field Study Training Program. Second Edition.

ERIC Educational Resources Information Center

Kerri, Kenneth D.; And Others

Proper installation, inspection, operation, maintenance, repair and management of water distribution systems have a significant impact on the operation and maintenance cost and effectiveness of the systems. The objective of this manual is to provide water distribution system operators with the knowledge and skills required to operate and maintain…

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

PubMed

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

2016-02-01

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

A mixed integer linear programming model for operational planning of a biodiesel supply chain network from used cooking oil

NASA Astrophysics Data System (ADS)

Jonrinaldi, Hadiguna, Rika Ampuh; Salastino, Rades

2017-11-01

Environmental consciousness has paid many attention nowadays. It is not only about how to recycle, remanufacture or reuse used end products but it is also how to optimize the operations of the reverse system. A previous research has proposed a design of reverse supply chain of biodiesel network from used cooking oil. However, the research focused on the design of the supply chain strategy not the operations of the supply chain. It only decided how to design the structure of the supply chain in the next few years, and the process of each stage will be conducted in the supply chain system in general. The supply chain system has not considered operational policies to be conducted by the companies in the supply chain. Companies need a policy for each stage of the supply chain operations to be conducted so as to produce the optimal supply chain system, including how to use all the resources that have been designed in order to achieve the objectives of the supply chain system. Therefore, this paper proposes a model to optimize the operational planning of a biodiesel supply chain network from used cooking oil. A mixed integer linear programming is developed to model the operational planning of biodiesel supply chain in order to minimize the total operational cost of the supply chain. Based on the implementation of the model developed, the total operational cost of the biodiesel supply chain incurred by the system is less than the total operational cost of supply chain based on the previous research during seven days of operational planning about amount of 2,743,470.00 or 0.186%. Production costs contributed to 74.6 % of total operational cost and the cost of purchasing the used cooking oil contributed to 24.1 % of total operational cost. So, the system should pay more attention to these two aspects as changes in the value of these aspects will cause significant effects to the change in the total operational cost of the supply chain.

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

PubMed

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

2016-03-01

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

Cost of Operating Central Cancer Registries and Factors That Affect Cost: Findings From an Economic Evaluation of Centers for Disease Control and Prevention National Program of Cancer Registries.

PubMed

Tangka, Florence K L; Subramanian, Sujha; Beebe, Maggie Cole; Weir, Hannah K; Trebino, Diana; Babcock, Frances; Ewing, Jean

2016-01-01

The Centers for Disease Control and Prevention (CDC) evaluated the economics of the National Program of Cancer Registries to provide the CDC, the registries, and policy makers with the economics evidence-base to make optimal decisions about resource allocation. Cancer registry budgets are under increasing threat, and, therefore, systematic assessment of the cost will identify approaches to improve the efficiencies of this vital data collection operation and also justify the funding required to sustain registry operations. To estimate the cost of cancer registry operations and to assess the factors affecting the cost per case reported by National Program of Cancer Registries-funded central cancer registries. We developed a Web-based cost assessment tool to collect 3 years of data (2009-2011) from each National Program of Cancer Registries-funded registry for all actual expenditures for registry activities (including those funded by other sources) and factors affecting registry operations. We used a random-effects regression model to estimate the impact of various factors on cost per cancer case reported. The cost of reporting a cancer case varied across the registries. Central cancer registries that receive high-quality data from reporting sources (as measured by the percentage of records passing automatic edits) and electronic data submissions, and those that collect and report on a large volume of cases had significantly lower cost per case. The volume of cases reported had a large effect, with low-volume registries experiencing much higher cost per case than medium- or high-volume registries. Our results suggest that registries operate with substantial fixed or semivariable costs. Therefore, sharing fixed costs among low-volume contiguous state registries, whenever possible, and centralization of certain processes can result in economies of scale. Approaches to improve quality of data submitted and increasing electronic reporting can also reduce cost.

Cost of Operating Central Cancer Registries and Factors That Affect Cost: Findings From an Economic Evaluation of Centers for Disease Control and Prevention National Program of Cancer Registries

PubMed Central

Tangka, Florence K. L.; Subramanian, Sujha; Beebe, Maggie Cole; Weir, Hannah K.; Trebino, Diana; Babcock, Frances; Ewing, Jean

2016-01-01

Context The Centers for Disease Control and Prevention evaluated the economics of the National Program of Cancer Registries to provide the Centers for Disease Control and Prevention, the registries, and policy makers with the economic evidence-base to make optimal decisions about resource allocation. Cancer registry budgets are under increasing threat, and, therefore, systematic assessment of the cost will identify approaches to improve the efficiencies of this vital data collection operation and also justify the funding required to sustain registry operations. Objectives To estimate the cost of cancer registry operations and to assess the factors affecting the cost per case reported by National Program of Cancer Registries–funded central cancer registries. Methods We developed a Web-based cost assessment tool to collect 3 years of data (2009-2011) from each National Program of Cancer Registries–funded registry for all actual expenditures for registry activities (including those funded by other sources) and factors affecting registry operations. We used a random-effects regression model to estimate the impact of various factors on cost per cancer case reported. Results The cost of reporting a cancer case varied across the registries. Central cancer registries that receive high-quality data from reporting sources (as measured by the percentage of records passing automatic edits) and electronic data submissions, and those that collect and report on a large volume of cases had significantly lower cost per case. The volume of cases reported had a large effect, with low-volume registries experiencing much higher cost per case than medium- or high-volume registries. Conclusions Our results suggest that registries operate with substantial fixed or semivariable costs. Therefore, sharing fixed costs among low-volume contiguous state registries, whenever possible, and centralization of certain processes can result in economies of scale. Approaches to improve quality of data submitted and increasing electronic reporting can also reduce cost. PMID:26642226

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

PubMed

Ho, David M; Huo, Michael H

2007-07-01

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

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

PubMed

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

2012-07-01

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

Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization.

PubMed

Brauer, David G; Hawkins, William G; Strasberg, Steven M; Brunt, L Michael; Jaques, David P; Mercurio, Nicholas R; Hall, Bruce L; Fields, Ryan C

2015-12-01

Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost-benefit associations will be necessary to justify expenditures in the era of bundled payment structures. All laparoscopic cholecystectomies (LCCKs) performed within a single health system over a 1-year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes. From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs. Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall cost, the opportunity exists for improved resource utilization with no obvious risk for a reduction in the quality of care. © 2015 International Hepato-Pancreato-Biliary Association.

Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: implications for standardization and improved resource utilization

PubMed Central

Brauer, David G; Hawkins, William G; Strasberg, Steven M; Brunt, L Michael; Jaques, David P; Mercurio, Nicholas R; Hall, Bruce L; Fields, Ryan C

2015-01-01

Background Payers and regulatory bodies are increasingly placing emphasis on cost containment, quality/outcome measurement and transparent reporting. Significant cost variation occurs in many operative procedures without a clear relationship with outcomes. Clear cost-benefit associations will be necessary to justify expenditures in the era of bundled payment structures. Methods All laparoscopic cholecystectomies (LCCKs) performed within a single health system over a 1-year period were analysed for operating room (OR) supply cost. The cost was correlated with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) outcomes. Results From July 2013 to June 2014, 2178 LCCKs were performed by 55 surgeons at seven hospitals. The median case OR supply cost was $513 ± 156. There was variation in cost between individual surgeons and within an individual surgeon's practice. There was no correlation between cost and ACS NSQIP outcomes. The majority of cost variation was explained by selection of trocar and clip applier constructs. Conclusions Significant case OR cost variation is present in LCCK across a single health system, and there is no clear association between increased cost and NSQIP outcomes. Placed within the larger context of overall cost, the opportunity exists for improved resource utilization with no obvious risk for a reduction in the quality of care. PMID:26345351

Optimal Design and Operation of Permanent Irrigation Systems

NASA Astrophysics Data System (ADS)

Oron, Gideon; Walker, Wynn R.

1981-01-01

Solid-set pressurized irrigation system design and operation are studied with optimization techniques to determine the minimum cost distribution system. The principle of the analysis is to divide the irrigation system into subunits in such a manner that the trade-offs among energy, piping, and equipment costs are selected at the minimum cost point. The optimization procedure involves a nonlinear, mixed integer approach capable of achieving a variety of optimal solutions leading to significant conclusions with regard to the design and operation of the system. Factors investigated include field geometry, the effect of the pressure head, consumptive use rates, a smaller flow rate in the pipe system, and outlet (sprinkler or emitter) discharge.

Mandible reconstruction with free fibula flaps: Outcome of a cost-effective individual planning concept compared with virtual surgical planning.

PubMed

Rommel, Niklas; Kesting, Marco Rainer; Rohleder, Nils Hagen; Bauer, Florian Martin Josef; Wolff, Klaus-Dietrich; Weitz, Jochen

2017-08-01

The free osteomyocutaneous fibular flap has become one of the primary options for mandibular reconstruction, because of the later introduction and development of virtual surgical planning (VSP). However, VSP is associated with high additional pre-operative effort and costs. Therefore, the purpose of the study was to develop a new individual cost-effective pre-operative planning concept for free fibula mandible reconstruction and to compare it with VSP regarding clinical parameters and post-operative outcome. 31 patients undergoing mandibular reconstruction with a microvascular free fibular flap were divided into two groups and retrospectively reviewed. For the first group A (18 of 31 patients), an individual method with stererolithographic (STL) models, silicon templates and hand-made cutting guides was used (about 250 € planning costs/patient). For the second group B (13 of 31 patients), VSP including pre-fabricated cutting guides was used (about 2500 € planning costs/patient). We found no statistically significant differences with respect to intra-operative time of mandibular reconstruction, duration of hospitalisation or post-operative complications between the two groups (p ≥ 0.05). The surgical outcomes and operative efficiency of this individual and cost-effective planning concept are comparable with the much more expensive complete VSP concept. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Reducing Operating Costs and Energy Consumption at Water Utilities

EPA Pesticide Factsheets

Due to their unique combination of high energy usage and potential for significant savings, utilities are turning to energy-efficient technologies to help save money. Learn about cost and energy saving technologies from this brochure.

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.

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

PubMed

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

2015-01-01

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

Operations and support cost modeling using Markov chains

NASA Technical Reports Server (NTRS)

Unal, Resit

1989-01-01

Systems for future missions will be selected with life cycle costs (LCC) as a primary evaluation criterion. This reflects the current realization that only systems which are considered affordable will be built in the future due to the national budget constaints. Such an environment calls for innovative cost modeling techniques which address all of the phases a space system goes through during its life cycle, namely: design and development, fabrication, operations and support; and retirement. A significant portion of the LCC for reusable systems are generated during the operations and support phase (OS). Typically, OS costs can account for 60 to 80 percent of the total LCC. Clearly, OS costs are wholly determined or at least strongly influenced by decisions made during the design and development phases of the project. As a result OS costs need to be considered and estimated early in the conceptual phase. To be effective, an OS cost estimating model needs to account for actual instead of ideal processes by associating cost elements with probabilities. One approach that may be suitable for OS cost modeling is the use of the Markov Chain Process. Markov chains are an important method of probabilistic analysis for operations research analysts but they are rarely used for life cycle cost analysis. This research effort evaluates the use of Markov Chains in LCC analysis by developing OS cost model for a hypothetical reusable space transportation vehicle (HSTV) and suggests further uses of the Markov Chain process as a design-aid tool.

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

PubMed

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

2010-10-01

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

A strategy for low cost development of incremental oil in legacy reservoirs

USGS Publications Warehouse

Attanasi, E.D.

2016-01-01

The precipitous decline in oil prices during 2015 has forced operators to search for ways to develop low-cost and low-risk oil reserves. This study examines strategies to low cost development of legacy reservoirs, particularly those which have already implemented a carbon dioxide enhanced oil recovery (CO2 EOR) program. Initially the study examines the occurrence and nature of the distribution of the oil resources that are targets for miscible and near-miscible CO2 EOR programs. The analysis then examines determinants of technical recovery through the analysis of representative clastic and carbonate reservoirs. The economic analysis focusses on delineating the dominant components of investment and operational costs. The concluding sections describe options to maximize the value of assets that the operator of such a legacy reservoir may have that include incremental expansion within the same producing zone and to producing zones that are laterally or stratigraphically near main producing zones. The analysis identified the CO2 recycle plant as the dominant investment cost item and purchased CO2 and liquids management as a dominant operational cost items. Strategies to utilize recycle plants for processing CO2 from multiple producing zones and multiple reservoir units can significantly reduce costs. Industrial sources for CO2 should be investigated as a possibly less costly way of meeting EOR requirements. Implementation of tapered water alternating gas injection schemes can partially mitigate increases in fluid lifting costs.

Small Water System Operations and Maintenance. A Field Study Training Program. Second Edition.

ERIC Educational Resources Information Center

Kerri, Kenneth D.; And Others

Proper installation, inspection, operation, maintenance, repair and management of small water systems have a significant impact on the operation and maintenance cost and effectiveness of the systems. The objective of this manual is to provide small water system operators with the knowledge and skills required to operate and maintain these systems…

Optimized molten salt receivers for ultimate trough solar fields

NASA Astrophysics Data System (ADS)

Riffelmann, Klaus-J.; Richert, Timo; Kuckelkorn, Thomas

2016-05-01

Today parabolic trough collectors are the most successful concentrating solar power (CSP) technology. For the next development step new systems with increased operation temperature and new heat transfer fluids (HTF) are currently developed. Although the first power tower projects have successfully been realized, up to now there is no evidence of an all-dominant economic or technical advantage of power tower or parabolic trough. The development of parabolic trough technology towards higher performance and significant cost reduction have led to significant improvements in competitiveness. The use of molten salt instead of synthetic oil as heat transfer fluid will bring down the levelized costs of electricity (LCOE) even further while providing dispatchable energy with high capacity factors. FLABEG has developed the Ultimate TroughTM (UT) collector, jointly with sbp Sonne GmbH and supported by public funds. Due to its validated high optical accuracy, the collector is very suitable to operate efficiently at elevated temperatures up to 550 °C. SCHOTT will drive the key-innovations by introducing the 4th generation solar receiver that addresses the most significant performance and cost improvement measures. The new receivers have been completely redesigned to provide a product platform that is ready for high temperature operation up to 550 °C. Moreover distinct product features have been introduced to reduce costs and risks in solar field assembly and installation. The increased material and design challenges incurred with the high temperature operation have been reflected in sophisticated qualification and validation procedures.

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

Code of Federal Regulations, 2010 CFR

2010-01-01

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

The roles of vibration analysis and infrared thermography in monitoring air-handling equipment

NASA Astrophysics Data System (ADS)

Wurzbach, Richard N.

2003-04-01

Industrial and commercial building equipment maintenance has not historically been targeted for implementation of PdM programs. The focus instead has been on manufacturing, aerospace and energy industries where production interruption has significant cost implications. As cost-effectiveness becomes more pervasive in corporate culture, even office space and labor activities housed in large facilities are being scrutinized for cost-cutting measures. When the maintenance costs for these facilities are reviewed, PdM can be considered for improving the reliability of the building temperature regulation, and reduction of maintenance repair costs. An optimized program to direct maintenance resources toward a cost effective and pro-active management of the facility can result in reduced operating budgets, and greater occupant satisfaction. A large majority of the significant rotating machinery in a large building environment are belt-driven air handling units. These machines are often poorly designed or utilized within the facility. As a result, the maintenance staff typically find themselves scrambling to replace belts and bearings, going from one failure to another. Instead of the reactive-mode maintenance, some progressive and critical institutions are adopting predictive and proactive technologies of infrared thermography and vibration analysis. Together, these technologies can be used to identify design and installation problems, that when corrected, significantly reduce maintenance and increase reliability. For critical building use, such as laboratories, research facilities, and other high value non-industrial settings, the cost-benefits of more reliable machinery can contribute significantly to the operational success.

Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs.

PubMed

Allen, Robert William; Pruitt, Mark; Taaffe, Kevin M

The operating room (OR) is a major driver of hospital costs; therefore, operative time is an expensive resource. The training of surgical residents must include time spent in the OR, but that experience comes with a cost to the surgeon and hospital. The objective of this article is to determine the effect of surgical resident involvement in the OR on operative time and subsequent hospital labor costs. The Kruskal-Wallis statistical test is used to determine whether or not there is a difference in operative times between 2 groups of cases (with residents and without residents). This difference leads to an increased cost in associated hospital labor costs for the group with the longer operative time. Cases were performed at Greenville Memorial Hospital. Greenville Memorial Hospital is part of the larger healthcare system, Greenville Health System, located in Greenville, SC and is a level 1 trauma center with up to 33 staffed ORs. A total of 84,997 cases were performed at the partnering hospital between January 1st, 2011 and July 31st, 2015. Cases were only chosen for analysis if there was only one CPT code associated with the case and there were more than 5 observations for each group being studied. This article presents a comprehensive retrospective analysis of 29,134 cases covering 246 procedures. The analysis shows that 45 procedures took significantly longer with a resident present in the room. The average increase in operative time was 4.8 minutes and the cost per minute of extra operative time was determined to be $9.57 per minute. OR labor costs at the partnering hospital was found to be $2,257,433, or $492,889 per year. Knowing the affect on operative time and OR costs allows managers to make smart decisions when considering alternative educational and training techniques. In addition, knowing the connection between residents in the room and surgical duration could help provide better estimates of surgical time in the future and increase the predictability of procedure duration. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Start-up and operating costs for artisan cheese companies.

PubMed

Bouma, Andrea; Durham, Catherine A; Meunier-Goddik, Lisbeth

2014-01-01

Lack of valid economic data for artisan cheese making is a serious impediment to developing a realistic business plan and obtaining financing. The objective of this study was to determine approximate start-up and operating costs for an artisan cheese company. In addition, values are provided for the required size of processing and aging facilities associated with specific production volumes. Following in-depth interviews with existing artisan cheese makers, an economic model was developed to predict costs based on input variables such as production volume, production frequency, cheese types, milk types and cost, labor expenses, and financing. Estimated values for start-up cost for processing and aging facility ranged from $267,248 to $623,874 for annual production volumes of 3,402 kg (7,500 lb) and 27,216 kg (60,000 lb), respectively. First-year production costs ranged from $65,245 to $620,094 for the above-mentioned production volumes. It is likely that high start-up and operating costs remain a significant entry barrier for artisan cheese entrepreneurs. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Subsurface Microsensors for Assisted Recertification of TPS (SmarTPS)

NASA Technical Reports Server (NTRS)

Pallix, Joan B.; Milos, Frank S.; Huestis, Dave; Arnold, James O. (Technical Monitor)

1999-01-01

Commercialization of a competitive reusable launch vehicle (RLV) is a primary goal for both NASA and the U.S. aerospace industry. To expedite achievement of this goal, the Bantam-X Technology Program is funding development of innovative technologies to lower costs for access to space. Ground operations is one area where significant cost reduction is required. For the Shuttle fleet, ground operations account for over 80% of the life cycle costs, and TPS recertification accounts for 27% of the operation costs ($4.5M per flight). Bantam Task TPS-7, Subsurface Microsensors for Assisted Recertification of TPS (SmarTPS), is a joint effort between NASA centers and industry partners to develop rapid remote detection and scanning technology for inspection of TPS and detection of subsurface defects. This short paper will provide a general overview of the SmarTPS concept.

Turnaround operations analysis for OTV. Volume 2: Detailed technical report

NASA Technical Reports Server (NTRS)

1988-01-01

The objectives and accomplishments were to adapt and apply the newly created database of Shuttle/Centaur ground operations. Previously defined turnaround operations analyses were to be updated for ground-based OTVs (GBOTVs) and space-based OTVs (SBOTVs), design requirements identified for both OTV and Space Station accommodations hardware, turnaround operations costs estimated, and a technology development plan generated to develop the required capabilities. Technical and programmatic data were provided for NASA pertinent to OTV round and space operations requirements, turnaround operations, task descriptions, timelines and manpower requirements, OTV modular design and booster and Space Station interface requirements. SBOTV accommodations development schedule, cost and turnaround operations requirements, and a technology development plan for ground and space operations and space-based accommodations facilities and support equipment. Significant conclusion are discussed.

Operationally Efficient Propulsion System Study (OEPSS) data book. Volume 4: OEPSS design concepts

NASA Technical Reports Server (NTRS)

Wong, George S.; Ziese, James M.; Farhangi, Shahram

1990-01-01

This study was initiated to identify operations problems and cost drivers for current propulsion systems and to identify technology and design approaches to increase the operational efficiency and reduce operations costs for future propulsion systems. To provide readily usable data for the Advanced Launch System (ALS) program, the results of the OEPSS study have been organized into a series of OEPSS Data Books. This volume describes three propulsion concepts that will simplify the propulsion system design and significantly reduce operational requirements. The concepts include: (1) a fully integrated, booster propulsion module concept for the ALS that avoids the complex system created by using autonomous engines with numerous artificial interfaces; (2) an LOX tank aft concept which avoids potentially dangerous geysering in long LOX propellant lines; and (3) an air augmented, rocket engine nozzle afterburning propulsion concept that will significantly reduce LOX propellant requirements, reduce vehicle size and simplify ground operations and ground support equipment and facilities.

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

PubMed

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

2015-01-01

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

Evaluation of optimal traffic monitoring station spacing on freeways.

DOT National Transportation Integrated Search

2009-02-01

Results showed that UDOT can reduce the number of detectors currently maintained by TMCs and can deploy far fewer than the mile spacing guidelines. This should result in significant cost savings in capital, operations, and maintenance costs. Fu...

[Complications and costs in primary knee replacement surgery in an endoprosthetics centre : Influence of state of training].

PubMed

Windisch, C; Brodt, S; Röhner, E; Matziolis, G

2017-04-01

This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S‑Op, T‑Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T‑Op and S‑Op were examined. The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S‑Op and those who had been operated by a T‑Op was made for all parameters. Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p‑o day. The T‑Op required an average of 11 min more than the S‑Op. CRP was significantly higher in the T‑Op group only on the third p‑o day, by 18 mg/l. In contrast, in the T‑Op group, a blood loss of 181 ml was lower than in the S‑Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S‑Op and T‑Op. In the setting of a certified endoprosthetics centre, the comparison of T‑Op with S‑Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.

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

PubMed

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

2004-01-01

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

Research requirements to reduce maintenance costs of civil helicopters

NASA Technical Reports Server (NTRS)

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

1978-01-01

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

Cost-effectiveness of laparoscopy in rectal cancer.

PubMed

Keller, Deborah S; Champagne, Bradley J; Reynolds, Harry L; Stein, Sharon L; Delaney, Conor P

2014-05-01

There is an increasing trend to use laparoscopy for rectal cancer surgery. Although laparoscopic and open rectal resections appear oncologically equivalent, there is little information on the cost of different surgical approaches. With the current health care crisis and the importance of optimizing health care resources and patient outcomes, the cost of care is an important factor. The aim of this study was to evaluate the cost-effectiveness of laparoscopy in rectal cancer. This was a case-matched study. This study was conducted at a tertiary referral center. Patients undergoing elective rectal cancer resection between 2007 and 2012 were selected. A review of a prospective database for elective laparoscopic rectal cancer resections was performed. Laparoscopic cases were matched to open cases based on age, BMI, operative procedure, and diagnostic-related group. The primary outcomes measured were the cost of care, hospital length of stay, discharge disposition, readmission, postoperative complications, and mortality rates. Two hundred fifty-four matched cases were included in the analysis: 125 laparoscopic (49%) and 129 open (51%). The cTNM stage (p = 0.39), tumor distance from the anal verge (p = 0.07), and rate of neoadjuvant therapy received between the laparoscopic and open groups were similar (p = 0.12). Operating time (p< 0.01) and cost per operating room minute (p = 0.04) were significantly higher in the open group. The groups were oncologically equivalent, based on circumferential resection margin (p = 0.15). The laparoscopic group had a significantly shorter length of stay (p < 0.01) and lower total hospital cost (p < 0.01). Postoperative complications, 30-day readmission, reoperation, and mortality rates were similar. However, significantly more patients undergoing open resection required intensive care unit care (p = 0.03), skilled nursing (p = 0.03), or home care services (p < 0.01) at discharge. This investigation was conducted at a single institution and it is a retrospective study with potential bias. Laparoscopy is cost-effective for rectal cancer surgery, improving both health care expenditures and patient outcomes. For selected patients, laparoscopic rectal cancer resection can reduce length of stay, operating time, and resource utilization.

Lower extremity endovascular interventions: can we improve cost-efficiency?

PubMed

O'Brien-Irr, Monica S; Harris, Linda M; Dosluoglu, Hasan H; Dayton, Merril; Dryjski, Maciej L

2008-05-01

Management of lower extremity arterial disease with endovascular intervention is on the rise. Current practice patterns vary widely across and within specialty practices that perform endovascular intervention. This study evaluated reimbursement and costs of different approaches for offering endovascular intervention and identified strategies to improve cost-efficiency. The medical records of all patients admitted to a university health system during 2005 for an endovascular intervention were retrospectively reviewed. Procedure type, setting, admission status, and financial data were recorded. Groups were compared using analysis of variance, Student t test for independent samples, and chi2. A total of 296 endovascular interventions were completed, and 184 (62%) met inclusion criteria. Atherectomy and stenting were significantly more costly when performed in the operating room than in the radiology suite: atherectomy, dollars 6596 vs dollars 4867 (P = .002); stent, dollars 5884 vs dollars 3292, (P < .001); angioplasty, dollars 2251 vs dollars 1881 (P = .46). Reimbursement was significantly higher for inpatient vs ambulatory admissions (P < .001). Costs were lowest when the endovascular intervention was done in the radiology suite on an ambulatory basis and highest when done as an inpatient in the operating room (dollars 5714 vs dollars 12,278; P < .001). Contribution margins were significantly higher for inpatients. Net profit was appreciated only for interventions done as an inpatient in the radiology suite. Reimbursement, contribution margins, and net profit were significantly lower among private pay patients in both the ambulatory and inpatient setting. The 30-day hospital readmission after ambulatory procedures was seven patients (6%). Practice patterns for endovascular interventions differ considerably. Costs vary by procedure and setting, and reimbursement depends on admission status and accurate documentation; these dynamics affect affordability. Organizing vascular services within a hub will ensure that care is delivered in the most cost-efficient manner. Guidelines may include designating the radiology suite as the primary venue for endovascular interventions because it is less costly than the operating room. Selective stenting policies should be considered. Contracts with private insurers must include carve-outs for stent costs and commensurate reimbursement for ambulatory procedures, and Current Procedural Terminology (CPT; American Medical Association, Chicago, Ill) coding must be proficient to make ambulatory endovascular interventions fiscally acceptable.

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

PubMed

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

2014-03-01

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

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

NASA Technical Reports Server (NTRS)

Smith, Dan; Bristow, John; Crouse, Patrick

2007-01-01

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

Upgrade of Compressed Air Control System Reduces Energy Costs at Michelin Tire Plant

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

None

2002-01-01

This case study highlights the upgraded compressed air system at a Michelin tire manufacturing plant in Spartanburg, South Carolina. The controls upgrade project enabled multiple compressor operation without blow-off, and significantly reduced energy costs.

The High Cost of Leaving: An Analysis of the Cost of Teacher Turnover

ERIC Educational Resources Information Center

Watlington, Eliah; Shockley, Robert; Guglielmino, Paul; Felsher, Rivka

2010-01-01

The cost of teacher turnover to schools and school districts has only recently been studied. This research reveals that when high-quality teachers leave the classroom, the effect on both student performance and school and district fiscal operations is significant and deleterious. The implications for study in this area include the planning of…

Increasing the Cost-efficiency of the DSN

NASA Technical Reports Server (NTRS)

Statman, Joseph I.; Berner, Jeff B.

2008-01-01

JPL has operated the Deep Space Network (DSN) on behalf of NASA since the 1960's. Over the last two decades, the DSN budget has generally declined in real-year dollars while the aging assets required more attention, and the missions became more complex. As a result, the budget has been increasingly consumed by Operations and Maintenance (O and M), significantly reducing the funding wedge available for technology investment and for enhancing the DSN capability and capacity. Responding to this budget squeeze, the DSN launched an effort to improve the cost-efficiency of the O and M. In this paper we: Analyze the components of O&M. We note for example that, for the DSN, less than 20% of the staff engage in the traditional human-in-front-a-console role, so any effort to increase the cost efficiency must go beyond reducing the number of "Real-time operators." Explain the underlying organizational and cultural structures. Any cost-efficiency activities changes either accept, or carefully modify these structures. For example, the DSN O&M is based on the concept that there are three nearly identical antenna complexes separated by approximately 1200 in latitude and that each antenna complex is operated by a different contractor (driven by international agreements). Explore planned changes in the customer interface, e.g. web-based automated scheduling, and the processes required for a transition. Changes have to be evaluated in the larger end-to-end context, e.g. do the changes provide a net cost-efficiency for the DSN and the missions, or do they merely shift cost from the DSN to the missions. Consider possible significant changes in real-time pass management, e.g. full-remoting of operations, and lights-dim operations, while maintaining (or improving) the performance metrics of the DSN. Investigate how procedural and administrative changes could increase cost-efficiency, in conjunction with changes in the customer interfaces and real-time pass management. Examples would be handling of inter-governmental agreements, improved sharing of resources with other agencies, and better use of commercial (rather than government) resources

Process for using surface strain measurements to obtain operational loads for complex structures

NASA Technical Reports Server (NTRS)

Ko, William L. (Inventor); Richards, William Lance (Inventor)

2010-01-01

The invention is an improved process for using surface strain data to obtain real-time, operational loads data for complex structures that significantly reduces the time and cost versus current methods.

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.

Clinical governance and operations management methodologies.

PubMed

Davies, C; Walley, P

2000-01-01

The clinical governance mechanism, introduced since 1998 in the UK National Health Service (NHS), aims to deliver high quality care with efficient, effective and cost-effective patient services. Scally and Donaldson recognised that new approaches are needed, and operations management techniques comprise potentially powerful methodologies in understanding the process of care, which can be applied both within and across professional boundaries. This paper summarises four studies in hospital Trusts which took approaches to improving process that were different from and less structured than business process re-engineering (BPR). The problems were then amenable to change at a relatively low cost and short timescale, producing significant improvement to patient care. This less structured approach to operations management avoided incurring overhead costs of large scale and costly change such as new information technology (IT) systems. The most successful changes were brought about by formal tools to control quantity, content and timing of changes.

Study to establish cost predictions for the production of Redox chemicals

NASA Technical Reports Server (NTRS)

Ammann, P. R.; Loreth, M.; Harvey, W. W.

1982-01-01

The chromium and iron chloride chemicals are significant first costs for NASA Redox energy storage systems. This study was performed to determine the lowest cost at which chromium and iron chlorides could be obtained for a complex of redox energy storage systems. In addition, since the solutions gradually become intermixed during the course of operation of Redox units, it was an objective to evaluate schemes for regeneration of the operating solutions. Three processes were evaluated for the production of chromium and iron chlorides. As a basis for the preliminary plant design and economic evaluation, it was assumed that the plant would produce about 25,000 tons of contained chromium as CrCl3 and an equivalent molar quantity of FeCl2. Preliminary plant designs, including materials and energy balances and sizing of major equipment, were prepared, and capital and operating costs were estimated.

Low-cost management aspects for developing, producing and operating future space transportation systems

NASA Astrophysics Data System (ADS)

Goehlich, Robert A.; Rücker, Udo

2005-01-01

It is believed that a potential means for further significant reduction of the recurrent launch cost, which results also in a stimulation of launch rates of small satellites, is to make the launcher reusable, to increase its reliability and to make it suitable for new markets such as mass space tourism. Therefore, not only launching small satellites with expendable rockets on non-regular flights but also with reusable rockets on regular flights should be considered for the long term. However, developing, producing and operating reusable rockets require a fundamental change in the current "business as usual" philosophy. Under current conditions, it might not be possible to develop, to produce or to operate a reusable vehicle fleet economically. The favorite philosophy is based on "smart business" processes adapted by the authors using cost engineering techniques. In the following paper, major strategies for reducing costs are discussed, which are applied for a representative program proposal.

Adoption of robotics in a general surgery residency program: at what cost?

PubMed

Mehaffey, J Hunter; Michaels, Alex D; Mullen, Matthew G; Yount, Kenan W; Meneveau, Max O; Smith, Philip W; Friel, Charles M; Schirmer, Bruce D

2017-06-01

Robotic technology is increasingly being utilized by general surgeons. However, the impact of introducing robotics to surgical residency has not been examined. This study aims to assess the financial costs and training impact of introducing robotics at an academic general surgery residency program. All patients who underwent laparoscopic or robotic cholecystectomy, ventral hernia repair (VHR), and inguinal hernia repair (IHR) at our institution from 2011-2015 were identified. The effect of robotic surgery on laparoscopic case volume was assessed with linear regression analysis. Resident participation, operative time, hospital costs, and patient charges were also evaluated. We identified 2260 laparoscopic and 139 robotic operations. As the volume of robotic cases increased, the number of laparoscopic cases steadily decreased. Residents participated in all laparoscopic cases and 70% of robotic cases but operated from the robot console in only 21% of cases. Mean operative time was increased for robotic cholecystectomy (+22%), IHR (+55%), and VHR (+61%). Financial analysis revealed higher median hospital costs per case for robotic cholecystectomy (+$411), IHR (+$887), and VHR (+$1124) as well as substantial associated fixed costs. Introduction of robotic surgery had considerable negative impact on laparoscopic case volume and significantly decreased resident participation. Increased operative time and hospital costs are substantial. An institution must be cognizant of these effects when considering implementing robotics in departments with a general surgery residency program. Copyright © 2017 Elsevier Inc. All rights reserved.

Single-stage-to-orbit: Meeting the challenge

NASA Astrophysics Data System (ADS)

Freeman, Delma C., Jr.; Talay, Theodore A.; Austin, Robert Eugene

1995-10-01

There has been and continues to be significant discussion about the viability of fully reusable, single-stage-to-orbit (SSTO) concepts for delivery of payloads to orbit. Often, these discussions have focused in detail on performance and technology requirements relating to the technical feasibility of the concept, with only broad generalizations on how the SSTO will achieve its economic goals of greatly reduced vehicle ground and flight operations costs. With the current industry and NASA Reusable Launch Vehicle Technology Program efforts underway to mature and demonstrate technologies leading to a viable commercial launch system that also satisfies national needs, achieving acceptable recurring costs becomes a significant challenge. This paper reviews the current status of the Reusable Launch Vehicle Technology Program including the DC-XA, X-33, and X-34 flight systems and associated technology programs. The paper also examines lessons learned from the recently completed DC-X reusable rocket demonstrator program. It examines how these technologies and flight systems address the technical and operability challenges of SSTO whose solutions are necessary to reduce costs. The paper also discusses the management and operational approaches that address the challenge of a new cost-effective, reusable launch vehicle system.

Single-stage-to-orbit — Meeting the challenge

NASA Astrophysics Data System (ADS)

Freeman, Delma C.; Talay, Theodore A.; Austin, Robert Eugene

1996-02-01

There has been and continues to be significant discussion about the viability of fully reusable, single-stage-to-orbit (SSTO) concepts for delivery of payloads to orbit. Often, these discussions have focused in detail on performance and technology requirements relating to the technical feasibility of the concept, with only broad generalizations on how the SSTO will achieve its economic goals of greatly reduced vehicle ground and flight operations costs. With the current industry and NASA Reusable Launch Vehicle Technology Program efforts underway to mature and demonstrate technologies leading to a viable commercial launch system that also satisfies national needs, achieving acceptable recurring costs becomes a significant challenge. This paper reviews the current status of the Reusable Launch Vehicle Technology Program including the DC-XA, X-33, X-34 flight systems and associated technology programs. The paper also examines lessons learned from the recently completed DC-X reusable rocket demonstrator program. It examines how these technologies and flight systems address the technical and operability challenges of SSTO whose solutions are necessary to reduce costs. The paper also discusses the management and operational approaches that address the challenge of a new cost-effective, reusable launch vehicle system.

Autonomous Aerobraking Using Thermal Response Surface Analysis

NASA Technical Reports Server (NTRS)

Prince, Jill L.; Dec, John A.; Tolson, Robert H.

2007-01-01

Aerobraking is a proven method of significantly increasing the science payload that can be placed into low Mars orbits when compared to an all propulsive capture. However, the aerobraking phase is long and has mission cost and risk implications. The main cost benefit is that aerobraking permits the use of a smaller and cheaper launch vehicle, but additional operational costs are incurred during the long aerobraking phase. Risk is increased due to the repeated thermal loading of spacecraft components and the multiple attitude and propulsive maneuvers required for successful aerobraking. Both the cost and risk burdens can be significantly reduced by automating the aerobraking operations phase. All of the previous Mars orbiter missions that have utilized aerobraking have increasingly relied on onboard calculations during aerobraking. Even though the temperature of spacecraft components has been the limiting factor, operational methods have relied on using a surrogate variable for mission control. This paper describes several methods, based directly on spacecraft component maximum temperature, for autonomously predicting the subsequent aerobraking orbits and prescribing apoapsis propulsive maneuvers to maintain the spacecraft within specified temperature limits. Specifically, this paper describes the use of thermal response surface analysis in predicting the temperature of the spacecraft components and the corresponding uncertainty in this temperature prediction.

Economic benefit of fertility control in wild horse populations

USGS Publications Warehouse

Bartholow, J.

2007-01-01

I projected costs for several contraceptive treatments that could be used by the Bureau of Land Management (BLM) to manage 4 wild horse (Equus caballus) populations. Potential management alternatives included existing roundup and selective removal methods combined with contraceptives of different duration and effectiveness. I projected costs for a 20-year economic life using the WinEquus?? wild horse population model and state-by-state cost estimates reflecting BLM's operational expenses. Findings revealed that 1) currently available 2-year contraceptives in most situations are capable of reducing variable operating costs by 15%, 2) experimental 3-year contraceptives may be capable of reducing costs by 18%, and 3) combining contraceptives with modest changes to herd sex ratio (e.g., 55-60% M) could trim costs by 30%. Predicted savings can increase when contraception is applied in conjunction with a removal policy that targets horses aged 0-4 years instead of 0-5 years. However, reductions in herd size result in greater variation in annual operating expenses. Because the horse program's variable operating costs make up about half of the total program costs (which include other fixed costs), contraceptive application and management can only reduce total costs by 14%, saving about $6.1 million per year. None of the contraceptive options I examined eliminated the need for long-term holding facilities over the 20-year period simulated, but the number of horses held may be reduced by about 17% with contraceptive treatment. Cost estimates were most sensitive to the oldest age adoptable and per-day holding costs. The BLM will experience significant cost savings as carefully designed contraceptive programs become widespread in the wild horse herds it manages.

A cost-effective analysis of fibrin sealants versus no sealant following open right hemihepatectomy for colorectal liver metastases.

PubMed

Pandanaboyana, Sanjay; Bell, Richard; Shah, Nehal; Lodge, J Peter A; Hidalgo, Ernest; Toogood, Giles J; Prasad, K Raj

2017-06-01

There is paucity of data regarding the cost-effectiveness of fibrin sealants during liver surgery. This study aimed to assess the cost-effectiveness of fibrin sealants following right hemihepatectomy for colorectal liver metastases. A prospectively maintained database between 2004 and 2013 was reviewed to identify patients who underwent a right hemihepatectomy with and without fibrin sealant application. Perioperative and post-operative outcomes were analysed to assess its cost-effectiveness. One hundred and sixty-three right hemihepatectomies were performed, of which 79 were in the fibrin sealant treatment group and 84 were in the no sealant group. No difference was seen between fibrin sealant and no sealant with regard to bile leak (P = 0.366), intra-abdominal collections (P = 0.200) and overall post-operative complications (P = 0.480). Operating costs were significantly cheaper in the no sealant group (P = 0.010). There was no difference seen in median post-operative stay between fibrin sealant versus no treatment (8 versus 9 days, P = 0.327), median total bed cost (£3900 versus £4300, P = 0.400), mean transfusion cost per patient (P = 0.201) and overall cost (£6706.15 versus £6555.80, P = 0.792). Fibrin sealant application to cut surface during liver surgery confers no cost benefit and their routine use may not be recommended. © 2014 Royal Australasian College of Surgeons.

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

NASA Astrophysics Data System (ADS)

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

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

Single-Use Energy Sources and Operating Room Time for Laparoscopic Hysterectomy: A Randomized Controlled Trial.

PubMed

Holloran-Schwartz, M Brigid; Gavard, Jeffrey A; Martin, Jared C; Blaskiewicz, Robert J; Yeung, Patrick P

2016-01-01

To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. A randomized controlled trial (Canadian Task Force Classification I). An academic hospital. Forty-six women who underwent laparoscopic hysterectomy from March 2013 to September 2013. Each patient served as her own control. One side of the uterine attachments was desiccated and transected with the single-use device (Ligasure 5-mm Blunt Tip LF1537 with the Force Triad generator). The other side was desiccated and transected with reusable bipolar forceps (RoBi 5 mm), and transected with monopolar scissors using the same Covidien Force Triad generator. The instrument approach used was randomized to the attending physician who was always on the patient's left side. Resident physicians always operated on the patient's right side and used the converse instruments of the attending physician. Start time was recorded at the utero-ovarian pedicle and end time was recorded after transection of the uterine artery on the same side. Costs included the single-use device; amortized costs of the generator, reusable instruments, and cords; cleaning and packaging of reusable instruments; and disposal of the single-use device. Operating room time was $94.14/min. We estimated that our single use-device cost $630.14 and had a total time savings of 6.7 min per case, or 3.35 min per side, which could justify the expense of the device. The single-use energy device had significant median time savings (-4.7 min per side, p < .001) and total intraoperative direct cost savings ($254.16 per case). A single-use energy device that both desiccates and cuts significantly reduced operating room time to justify its own cost, and it also reduced total intraoperative direct costs during laparoscopic hysterectomy in our institution. Operating room cost per minute varies between institutions and must be considered before generalizing our results. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Lunar COTS: An Economical and Sustainable Approach to Reaching Mars

NASA Technical Reports Server (NTRS)

Zuniga, Allison F.; Rasky, Daniel; Pittman, Robert B.; Zapata, Edgar; Lepsch, Roger

2015-01-01

The NASA COTS (Commercial Orbital Transportation Services) Program was a very successful program that developed and demonstrated cost-effective development and acquisition of commercial cargo transportation services to the International Space Station (ISS). The COTS acquisition strategy utilized a newer model than normally accepted in traditional procurement practices. This new model used Space Act Agreements where NASA entered into partnerships with industry to jointly share cost, development and operational risks to demonstrate new capabilities for mutual benefit. This model proved to be very beneficial to both NASA and its industry partners as NASA saved significantly in development and operational costs while industry partners successfully expanded their market share of the global launch transportation business. The authors, who contributed to the development of the COTS model, would like to extend this model to a lunar commercial services program that will push development of technologies and capabilities that will serve a Mars architecture and lead to an economical and sustainable pathway to transporting humans to Mars. Over the past few decades, several architectures for the Moon and Mars have been proposed and studied but ultimately halted or not even started due to the projected costs significantly exceeding NASA's budgets. Therefore a new strategy is needed that will fit within NASA's projected budgets and takes advantage of the US commercial industry along with its creative and entrepreneurial attributes. The authors propose a new COTS-like program to enter into partnerships with industry to demonstrate cost-effective, cis-lunar commercial services, such as lunar transportation, lunar ISRU operations, and cis-lunar propellant depots that can enable an economical and sustainable Mars architecture. Similar to the original COTS program, the goals of the proposed program, being notionally referred to as Lunar Commercial Orbital Transfer Services (LCOTS) program will be to: 1) reduce development and operational costs by sharing costs with industry; 2) create new markets in cis-lunar space to further reduce operational costs; and 3) enable NASA to develop an affordable and economical exploration Mars architecture. The paper will describe a plan for a proposed LCOTS program, its potential impact to an eventual Mars architecture and its many benefits to NASA, commercial space industry and the US economy.

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

PubMed

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

2015-08-01

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

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

PubMed

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

2004-10-01

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

Cost Accounting as a Tool for Increasing Cost Transparency in Selective Hepatic Transarterial Chemoembolization.

PubMed

Ahmed, Osman; Patel, Mikin; Ward, Thomas; Sze, Daniel Y; Telischak, Kristen; Kothary, Nishita; Hofmann, Lawrence V

2015-12-01

To increase cost transparency and uncover potential areas for savings in patients receiving selective transarterial chemoembolization at a tertiary care academic center. The hospital cost accounting system charge master sheet for direct and total costs associated with selective transarterial chemoembolization in fiscal years 2013 and 2014 was queried for each of the four highest volume interventional radiologists at a single institution. There were 517 cases (range, 83-150 per physician) performed; direct costs incurred relating to care before, during, and after the procedure with respect to labor, supply, and equipment fees were calculated. A median of 48 activity codes were charged per selective transarterial chemoembolization from five cost centers, represented by the angiography suite, units for care before and after the procedure, pharmacy, and observation floors. The average direct cost of selective transarterial chemoembolization did not significantly differ among operators at $9,126.94, $8,768.77, $9,027.33, and $8,909.75 (P = .31). Intraprocedural costs accounted for 82.8% of total direct costs and provided the greatest degree in cost variability ($7,268.47-$7,691.27). The differences in intraprocedural expense among providers were not statistically significant (P = .09), even when separated into more specific procedure-related labor and supply costs. Cost accounting systems could effectively be interrogated as a method for calculating direct costs associated with selective transarterial chemoembolization. The greatest source of expenditure and variability in cost among providers was shown to be intraprocedural labor and supplies, although the effect did not appear to be operator dependent. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2011-07-01

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

Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization.

PubMed

Panni, Roheena Z; Ashfaq, Awais; Amanullah, Muhammad M

2011-12-29

Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively; among patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan. A prevalence based cost of illness study design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children ≤ 5 years of age from June 2006 to June 2009. A total of 120 patients were enrolled after obtaining an informed consent and the data was collected using a pre-tested questionnaire. The mean age at the time of surgery in group A (1-12 mo age) was 6.08 ± 2.80 months and in group B (1-5 yrs) was 37.10 ± 19.94 months. The cost of surgical admission was found to be significantly higher in the older group, p = 0.001. The total number and cost of post-operative outpatient visits was also higher in group B, p = 0.003. Pre and post operative hospital admissions were not found to be significantly different among the two groups, p = 0.166 and 0.627, respectively. The number of complications were found to be different between the two groups (p = 0.019). Majority of these were contributed by hemorrhage and post-operative seizures. This study concluded that significant expenditure is incurred by people with CHD; with the implication that resources could be saved by earlier detection and awareness campaigns.

VAR and generalized impulse response analysis of manufacturing unit labor costs

NASA Astrophysics Data System (ADS)

Ewing, Bradley T.; Thompson, Mark A.

2008-04-01

This paper examines the relationship among manufacturing unit labor costs in the United States, United Kingdom, and Canada. The analysis is conducted within the context of an economic system utilizing the recently developed method of generalized impulse response analysis to simulate the responses of the cost series to disturbances. The results indicate that, while unit labor costs do not share a common stochastic trend, there are significant responses in the unit labor costs of each country to shocks in the costs of other countries that are not captured by standard interpretation of the multiple-equation model results. The findings indicate the presence of significant linkages among unit labor costs in the countries studied. The results are consistent with the economic environment of manufacturing operations being characterized by a competitive, integrated marketplace.

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

PubMed Central

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

2016-01-01

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

Shared mission operations concept

NASA Technical Reports Server (NTRS)

Spradlin, Gary L.; Rudd, Richard P.; Linick, Susan H.

1994-01-01

Historically, new JPL flight projects have developed a Mission Operations System (MOS) as unique as their spacecraft, and have utilized a mission-dedicated staff to monitor and control the spacecraft through the MOS. NASA budgetary pressures to reduce mission operations costs have led to the development and reliance on multimission ground system capabilities. The use of these multimission capabilities has not eliminated an ongoing requirement for a nucleus of personnel familiar with a given spacecraft and its mission to perform mission-dedicated operations. The high cost of skilled personnel required to support projects with diverse mission objectives has the potential for significant reduction through shared mission operations among mission-compatible projects. Shared mission operations are feasible if: (1) the missions do not conflict with one another in terms of peak activity periods, (2) a unique MOS is not required, and (3) there is sufficient similarity in the mission profiles so that greatly different skills would not be required to support each mission. This paper will further develop this shared mission operations concept. We will illustrate how a Discovery-class mission would enter a 'partner' relationship with the Voyager Project, and can minimize MOS development and operations costs by early and careful consideration of mission operations requirements.

Multi-objective optimisation of wastewater treatment plant control to reduce greenhouse gas emissions.

PubMed

Sweetapple, Christine; Fu, Guangtao; Butler, David

2014-05-15

This study investigates the potential of control strategy optimisation for the reduction of operational greenhouse gas emissions from wastewater treatment in a cost-effective manner, and demonstrates that significant improvements can be realised. A multi-objective evolutionary algorithm, NSGA-II, is used to derive sets of Pareto optimal operational and control parameter values for an activated sludge wastewater treatment plant, with objectives including minimisation of greenhouse gas emissions, operational costs and effluent pollutant concentrations, subject to legislative compliance. Different problem formulations are explored, to identify the most effective approach to emissions reduction, and the sets of optimal solutions enable identification of trade-offs between conflicting objectives. It is found that multi-objective optimisation can facilitate a significant reduction in greenhouse gas emissions without the need for plant redesign or modification of the control strategy layout, but there are trade-offs to consider: most importantly, if operational costs are not to be increased, reduction of greenhouse gas emissions is likely to incur an increase in effluent ammonia and total nitrogen concentrations. Design of control strategies for a high effluent quality and low costs alone is likely to result in an inadvertent increase in greenhouse gas emissions, so it is of key importance that effects on emissions are considered in control strategy development and optimisation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Advanced Launch System (ALS) actuation and power systems impact operability and cost

NASA Technical Reports Server (NTRS)

Sundberg, Gale R.

1990-01-01

To obtain the Advanced Launch System (ALS) primary goals of reduced costs and improved operability, there must be significant reductions in the launch operations and servicing requirements relative to current vehicle designs and practices. One of the primary methods for achieving these goals is by using vehicle electrical power system and controls for all actuation and avionics requirements. A brief status review of the ALS and its associated Advanced Development Program is presented to demonstrate maturation of those technologies that will help meet the overall operability and cost goals. The electric power and actuation systems are highlighted as a specific technology ready not only to meet the stringent ALS goals (cryogenic field valves and thrust vector controls with peak power demands to 75 hp), but also those of other launch vehicles, military and civilian aircraft, lunar/Martian vehicles, and a multitude of commercial applications.

Advanced Launch System (ALS): Electrical actuation and power systems improve operability and cost picture

NASA Technical Reports Server (NTRS)

Sundberg, Gale R.

1990-01-01

To obtain the Advanced Launch System (ALS) primary goals of reduced costs and improved operability, there must be significant reductions in the launch operations and servicing requirements relative to current vehicle designs and practices. One of the primary methods for achieving these goals is by using vehicle electrical power system and controls for all actuation and avionics requirements. A brief status review of the ALS and its associated Advanced Development Program is presented to demonstrate maturation of those technologies that will help meet the overall operability and cost goals. The electric power and actuation systems are highlighted as a specific technology ready not only to meet the stringent ALS goals (cryogenic field valves and thrust vector controls with peak power demands to 75 hp), but also those of other launch vehicles, military and civilian aircraft, lunar/Martian vehicles, and a multitude of commercial applications.

Advanced launch system (ALS) - Electrical actuation and power systems improve operability and cost picture

NASA Technical Reports Server (NTRS)

Sundberg, Gale R.

1990-01-01

To obtain the Advanced Launch System (ALS) primary goals of reduced costs and improved operability, there must be significant reductions in the launch operations and servicing requirements relative to current vehicle designs and practices. One of the primary methods for achieving these goals is by using vehicle electrrical power system and controls for all aviation and avionics requirements. A brief status review of the ALS and its associated Advanced Development Program is presented to demonstrate maturation of those technologies that will help meet the overall operability and cost goals. The electric power and actuation systems are highlighted as a sdpecific technology ready not only to meet the stringent ALS goals (cryogenic field valves and thrust vector controls with peak power demands to 75 hp), but also those of other launch vehicles, military ans civilian aircraft, lunar/Martian vehicles, and a multitude of comercial applications.

Reducing air pollutant emissions at airports by controlling aircraft ground operations

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

Gelinas, C.G.; Fan, H.S.L.

1979-02-01

Potential reductions in air pollutant emissions were determined for four stategies to control aircraft ground operations at two case study airports, Los Angeles and San Francisco International Airports. Safety, cost, and fuel savings associated with strategy implementation were examined. Two strategies, aircraft towing and shutdown of one engine during taxi operations, provided significant emission reductions. However, there are a number of safety problems associated with aircraft towing. The shutdown of one engine while taxiing was found to be the most viable strategy because of substantial emission reductions, cost benefits resulting from fuel savings, and no apparent safety problems.

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

Easton, C. R.

The objectives of this program are to establish a heliostat design with the associated manufacturing, assembly, installation and maintenance approaches that will: (1) yield a significant reduction of capital and operating costs; (2) meet performance specifications for large collector subsystems; and (3) can be produced and deployed throughout the southwestern United States. In addition, cost plans and schedules to develop, fabricate, and operate the heliostat are to be developed. This volume presents the collector design, including trade study and test results, and the manufacturing, installation and checkout, and operations and maintenance concepts. Also, a discussion of specification verification and optimizationmore » is included. (WHK)« less

Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis.

PubMed

Restrepo, Ruben D; Braverman, Jane

2015-02-01

Innovations in surgery have significantly increased the number of procedures performed every year. While more individuals benefit from better surgical techniques and technology, a larger group of patients previously deemed ineligible for surgery now undergo high-complexity surgical procedures. Despite continuous improvements in the operating room and post-operative care, post-operative pulmonary complications (PPCs) continue to pose a serious threat to successful outcomes. PPCs are common, serious and costly. Growing awareness of the impact of PPCs has led to intensified efforts to understand the underlying causes. Current evidence demonstrates that a high proportion of PPCs are directly traceable to the pre-operative risk for and perioperative development of atelectasis. The substantial costs and losses associated with PPCs demand strategies to reduce their prevalence and impact. Effective interventions will almost certainly produce cost savings that significantly offset current economic and human resource expenditures. The purpose of this review is to describe the most common challenges encountered in the recognition, prevention and management of perioperative atelectasis. Expanding awareness and understanding of the role of atelectasis as a cause of PPCs can reduce their prevalence, impact important clinical outcomes and reduce the financial burden associated with treating these complications.

Evaluation of The Operational Benefits Versus Costs of An Automated Cargo Mover

DTIC Science & Technology

2016-12-01

logistics footprint and life-cycle cost are presented as part of this report. Analysis of modeling and simulation results identified statistically...life-cycle cost are presented as part of this report. Analysis of modeling and simulation results identified statistically significant differences...Error of Estimation. Source: Eskew and Lawler (1994). ...........................75 Figure 24. Load Results (100 Runs per Scenario

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

PubMed

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

2016-02-05

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

Scale Matters: A Cost-Outcome Analysis of an m-Health Intervention in Malawi.

PubMed

Larsen-Cooper, Erin; Bancroft, Emily; Rajagopal, Sharanya; O'Toole, Maggie; Levin, Ann

2016-04-01

The primary objectives of this study are to determine cost per user and cost per contact with users of a mobile health (m-health) intervention. The secondary objectives are to map costs to changes in maternal, newborn, and child health (MNCH) and to estimate costs of alternate implementation and usage scenarios. A base cost model, constructed from recurrent costs and selected capital costs, was used to estimate average cost per user and per contact of an m-health intervention. This model was mapped to statistically significant changes in MNCH intermediate outcomes to determine the cost of improvements in MNCH indicators. Sensitivity analyses were conducted to estimate costs in alternate scenarios. The m-health intervention cost $29.33 per user and $4.33 per successful contact. The average cost for each user experiencing a change in an MNCH indicator ranged from $67 to $355. The sensitivity analyses showed that cost per user could be reduced by 48% if the service were to operate at full capacity. We believe that the intervention, operating at scale, has potential to be a cost-effective method for improving maternal and child health indicators.

Scale Matters: A Cost-Outcome Analysis of an m-Health Intervention in Malawi

PubMed Central

Bancroft, Emily; Rajagopal, Sharanya; O'Toole, Maggie; Levin, Ann

2016-01-01

Abstract Background: The primary objectives of this study are to determine cost per user and cost per contact with users of a mobile health (m-health) intervention. The secondary objectives are to map costs to changes in maternal, newborn, and child health (MNCH) and to estimate costs of alternate implementation and usage scenarios. Materials and Methods: A base cost model, constructed from recurrent costs and selected capital costs, was used to estimate average cost per user and per contact of an m-health intervention. This model was mapped to statistically significant changes in MNCH intermediate outcomes to determine the cost of improvements in MNCH indicators. Sensitivity analyses were conducted to estimate costs in alternate scenarios. Results: The m-health intervention cost $29.33 per user and $4.33 per successful contact. The average cost for each user experiencing a change in an MNCH indicator ranged from $67 to $355. The sensitivity analyses showed that cost per user could be reduced by 48% if the service were to operate at full capacity. Conclusions: We believe that the intervention, operating at scale, has potential to be a cost-effective method for improving maternal and child health indicators. PMID:26348994

A description of morbidly obese state employees requesting a bariatric operation.

PubMed

Martin, Louis F; Lundberg, Anna Paone; Juneau, Francine; Raum, William J; Hartman, Sandra J

2005-10-01

The federal government, the medical insurance industry, and the academic medical community have disagreed over what treatments are appropriate and cost effective for morbid obesity. This debate is hindered by inadequate data regarding the true costs of diseases and who chooses an operation as a treatment option. The purpose of this study was to obtain these costs and to describe this population. Louisiana's managed medical insurance program created primarily for its civil service employees contracted to offer a small random group of morbidly obese employees the option of a bariatric operation. This observational study examined the subpopulation who requested consideration for the operation. We present historic cost data from all medical expenses paid by the insurance company, a telephone survey of the volunteers in the study to determine their medical problems, and diagnostic evaluation data on those employees randomized to proceed for possible bariatric operation. A total of 911 of 189,398 adult members of the insurance plan wanted to be considered for this study. Only 397, however, completed the informed-consent process. Of the 248 employees who met the age requirement, body mass index criteria, and health criteria to be considered for a bariatric operation and were randomized, 20 withdrew before obtaining 40 committed operative candidates. The 773 morbidly obese female members had used a mean of dollar 11,145 in medical insurance expenses in the year 2003 versus a mean of dollar 8,096 for the other 106,908 adult women. Similar values for the men were dollar 16,720 for the 138 morbidly obese men versus dollar 5,943 for the other 82,490 men. The morbidly obese members of this medical insurance plan who requested a bariatric operation are costing their plan 1.4 to 2.8 times the yearly amount of the other adult members in medical expenses. The yearly mean amount the insurance plan spends on these members suggests that operative treatment would pay for itself in a relatively few number of years if it could significantly reduce these costs. Even in those who consider bariatric operation, many withdraw, further limiting the costs of operative therapy.

The business case for the reduction of surgical complications in VA hospitals.

PubMed

Vaughan-Sarrazin, Mary; Bayman, Levent; Rosenthal, Gary; Henderson, William; Hendricks, Ann; Cullen, Joseph J

2011-04-01

Surgical complications contribute substantially to costs. Most important, surgical complications contribute to morbidity and mortality, and some may be preventable. This study estimates costs of specific surgical complications for patients undergoing general surgery in VA hospitals using merged data from the VA Surgical Quality Improvement Program and VA Decision Support System. Costs associated with 19 potentially preventable complications within 6 broader categories were estimated using generalized, linear mixed regression models to control for patient-level determinants of costs (eg, type of operation, demographics, comorbidity, severity) and hospital-level variation in costs. Costs included costs of the index hospitalization and subsequent 30-day readmissions. In 14,639 patients undergoing general surgical procedures from 10/2005 through 9/2006, 20% of patients developed postoperative surgical complications. The presence of any complication significantly increased unadjusted costs nearly 3-fold ($61,083 vs $22,000), with the largest cost differential attributed to respiratory complications. Patients who developed complications had several markers for greater preoperative severity, including increased age and a lesser presurgery functional health status. After controlling for differences in patient severity, costs for patients with any complication were 1.89 times greater compared to costs for patients with no complications (P < .0001). Within major complication categories, adjusted costs were significantly greater for patients with respiratory, cardiac, central nervous system, urinary, wound, or other complications. Surgical complications contribute markedly to costs of inpatient operations. Investment in quality improvement that decreases the incidence of surgical complications could decrease costs. Copyright © 2011 Mosby, Inc. All rights reserved.

Integrated orbital servicing study for low-cost payload programs. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Derocher, W. L., Jr.

1975-01-01

Various operating methodologies to achieve low-cost space operations were investigated as part of the Space Transportation System (STS) planning. The emphasis was to show that the development investment, initial fleet costs, and supporting facilities for the STS could be effectively offset by exploiting the capabilities of the STS to satisfy mission requirements and reduce the cost of payload programs. The following major conclusions were reached: (1) the development of an on-orbit servicer maintenance system is compatible with many spacecraft programs and is recommended as the most cost-effective system, (2) spacecraft can be designed to be serviceable with acceptable design, weight, volume, and cost effects, (3) use of on-orbit servicing over a 12 year period results in savings ranging between four and nine billion dollars, (4) the pivoting arm on-orbit servicer was selected and a preliminary design was prepared, (5) orbital maintenance has no significant impact on the STS.

Energy sources for laparoscopic colectomy: a prospective randomized comparison of conventional electrosurgery, bipolar computer-controlled electrosurgery and ultrasonic dissection. Operative outcome and costs analysis.

PubMed

Targarona, Eduardo Ma; Balague, Carmen; Marin, Juan; Neto, Rene Berindoague; Martinez, Carmen; Garriga, Jordi; Trias, Manuel

2005-12-01

The development of operative laparoscopic surgery is linked to advances in ancillary surgical instrumentation. Ultrasonic energy devices avoid the use of electricity and provide effective control of small- to medium-sized vessels. Bipolar computer-controlled electrosurgical technology eliminates the disadvantages of electrical energy, and a mechanical blade adds a cutting action. This instrument can provide effective hemostasis of large vessels up to 7 mm. Such devices significantly increase the cost of laparoscopic procedures, however, and the amount of evidence-based information on this topic is surprisingly scarce. This study compared the effectiveness of three different energy sources on the laparoscopic performance of a left colectomy. The trial included 38 nonselected patients with a disease of the colon requiring an elective segmental left-sided colon resection. Patients were preoperatively randomized into three groups. Group I had electrosurgery; vascular dissection was performed entirely with an electrosurgery generator, and vessels were controlled with clips. Group II underwent computer-controlled bipolar electrosurgery; vascular and mesocolon section was completed by using the 10-mm Ligasure device alone. In group III, 5-mm ultrasonic shears (Harmonic Scalpel) were used for bowel dissection, vascular pedicle dissection, and mesocolon transection. The mesenteric vessel pedicle was controlled with an endostapler. Demographics (age, sex, body mass index, comorbidity, previous surgery and diagnoses requiring surgery) were recorded, as were surgical details (operative time, conversion, blood loss), additional disposable instruments (number of trocars, EndoGIA charges, and clip appliers), and clinical outcome. Intraoperative economic costs were also evaluated. End points of the trial were operative time and intraoperative blood loss, and an intention-to-treat principle was followed. The three groups were well matched for demographic and pathologic features. Surgical time was significantly longer in patients operated on with conventional electrosurgery vs the Harmonic Scalpel or computed-based bipolar energy devices. This finding correlated with a significant reduction in intraoperative blood loss. Conversion to other endoscopic techniques was more frequent in Group I; however, conversion to open surgery was similar in all three groups. No intraoperative accident related to the use of the specific device was observed in any group. Immediate outcome was similar in the three groups, without differences in morbidity, mortality, or hospital stay. Analysis of operative costs showed no significant differences between the three groups. High-energy power sources specifically adapted for endoscopic surgery reduce operative time and blood loss and may be considered cost-effective when left colectomy is used as a model.

Cost accounting in radiation oncology: a computer-based model for reimbursement.

PubMed

Perez, C A; Kobeissi, B; Smith, B D; Fox, S; Grigsby, P W; Purdy, J A; Procter, H D; Wasserman, T H

1993-04-02

The skyrocketing cost of medical care in the United States has resulted in multiple efforts in cost containment. The present work offers a rational computer-based cost accounting approach to determine the actual use of resources in providing a specific service in a radiation oncology center. A procedure-level cost accounting system was developed by using recorded information on actual time and effort spent by individual staff members performing various radiation oncology procedures, and analyzing direct and indirect costs related to staffing (labor), facilities and equipment, supplies, etc. Expenditures were classified as direct or indirect and fixed or variable. A relative value unit was generated to allocate specific cost factors to each procedure. Different costs per procedure were identified according to complexity. Whereas there was no significant difference in the treatment time between low-energy (4 and 6 MV) or high-energy (18 MV) accelerators, there were significantly higher costs identified in the operation of a high-energy linear accelerator, a reflection of initial equipment investment, quality assurance and calibration procedures, maintenance costs, service contract, and replacement parts. Utilization of resources was related to the complexity of the procedures performed and whether the treatments were delivered to inpatients or outpatients. In analyzing time motion for physicians and other staff, it was apparent that a greater effort must be made to train the staff to accurately record all times involved in a given procedure, and it is strongly recommended that each institution perform its own time motion studies to more accurately determine operating costs. Sixty-six percent of our facility's global costs were for labor, 20% for other operating expenses, 10% for space, and 4% for equipment. Significant differences were noted in the cost allocation for professional or technical functions, as labor, space, and equipment costs are higher in the latter. External beam treatment-related procedures accounted for more than 50% of all technical and professional revenues, simulation for 8% to 10%, and other physics/dosimetry procedures for 11% to 14% of revenues. Some discrepancies were identified between the actual cost and level of reimbursement of various procedures. Details are described in the manuscript. It is imperative to develop an equitable reimbursement system for radiation oncology services, based on cost accounting and other measures that may enhance productivity and reduce the cost per procedure unit, while at the same time preserving the highest quality of service provided to patients.

Economic and environmental costs of regulatory uncertainty for coal-fired power plants.

PubMed

Patiño-Echeverri, Dalia; Fischbeck, Paul; Kriegler, Elmar

2009-02-01

Uncertainty about the extent and timing of CO2 emissions regulations for the electricity-generating sector exacerbates the difficulty of selecting investment strategies for retrofitting or alternatively replacing existent coal-fired power plants. This may result in inefficient investments imposing economic and environmental costs to society. In this paper, we construct a multiperiod decision model with an embedded multistage stochastic dynamic program minimizing the expected total costs of plant operation, installations, and pollution allowances. We use the model to forecast optimal sequential investment decisions of a power plant operator with and without uncertainty about future CO2 allowance prices. The comparison of the two cases demonstrates that uncertainty on future CO2 emissions regulations might cause significant economic costs and higher air emissions.

Operation and Maintenance of Wastewater Collection Systems. Volume I. Third Edition. A Field Study Training Program.

ERIC Educational Resources Information Center

California State Univ., Sacramento. Dept. of Civil Engineering.

Proper installations, inspections, operations, maintenance and repairs of wastewater collection, conveyance and treatment facilities have a significant impact on the operation and maintenance costs, and the effectiveness of these facilities. This manual is the first volume of a two-part program designed to provide wastewater collection system…

Application of propfan propulsion to general aviation

NASA Technical Reports Server (NTRS)

Awker, R. W.

1986-01-01

Recent studies of advanced propfan propulsion systems have shown significant reductions in fuel consumption of 15-30 percent for transport class aircraft. This paper presents the results of a study which examined applying propfan propulsion to General Aviation class aircraft to determine if similar improvements could be achieved for business aircraft. In addition to the potential performance gains, this paper also addresses the cost aspects of propfan propulsion on General Aviation aircraft emphasizing the significant impact that the cost of capital and tax aspects have on determining the total cost of operation for business aircraft.

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

PubMed

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

2016-09-01

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

Trustees and Toxic Waste: New Concern in the Boardroom.

ERIC Educational Resources Information Center

Wallach, Paul G.

1987-01-01

Although environmental compliance is a significant cost of college operations, very few colleges have made a bona fide effort to develop cost-effective compliance strategies. Colleges are no longer being passed over in the application of the environment laws, including the stringent new criminal provisions. (MLW)

Analysis of environmental constraints on expanding reserves in current and future reservoirs in wetlands. Final report

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

Harder, B.J.

1995-03-01

Louisiana wetlands require careful management to allow exploitation of non-renewable resources without destroying renewable resources. Current regulatory requirements have been moderately successful in meeting this goal by restricting development in wetland habitats. Continuing public emphasis on reducing environmental impacts of resource development is causing regulators to reassess their regulations and operators to rethink their compliance strategies. We examined the regulatory system and found that reducing the number of applications required by going to a single application process and having a coherent map of the steps required for operations in wetland areas would reduce regulatory burdens. Incremental changes can be mademore » to regulations to allow one agency to be the lead for wetland permitting at minimal cost to operators. Operators need cost effective means of access that will reduce environmental impacts, decrease permitting time, and limit future liability. Regulators and industry must partner to develop incentive based regulations that can provide significant environmental impact reduction for minimal economic cost. In addition regulators need forecasts of future E&P trends to estimate the impact of future regulations. To determine future activity we attempted to survey potential operators when this approach was unsuccessful we created two econometric models of north and south Louisiana relating drilling activity, success ratio, and price to predict future wetland activity. Results of the econometric models indicate that environmental regulations have a small but statistically significant effect on drilling operations in wetland areas of Louisiana. We examined current wetland practices and evaluated those practices comparing environmental versus economic costs and created a method for ranking the practices.« less

Shuttle's 160 hour ground turnaround - A design driver

NASA Technical Reports Server (NTRS)

Widick, F.

1977-01-01

Turnaround analysis added a new dimension to the Space Program with the advent of the Space Shuttle. The requirement to turn the flight hardware around in 160 working hours from landing to launch was a significant design driver and a useful tool in forcing the integration of flight and ground systems design to permit an efficient ground operation. Although there was concern that time constraints might increase program costs, the result of the analysis was to minimize facility requirements and simplify operations with resultant cost savings.

An Approach to Establishing System Benefits for Technologies In NASA's Spaceliner Investment Area

NASA Technical Reports Server (NTRS)

Hueter, Uwe; Pannell, Bill; Lyles, Garry M. (Technical Monitor)

2001-01-01

NASA's has established long term goals for access-to-space. The third generation launch systems are to be fully reusable and operational around 2025. The goals for the third generation launch system are to significantly reduce cost and improve safety over current systems. The Advanced Space Transportation Program Office (ASTP) at the NASA's Marshall Space Flight Center in Huntsville, AL has the agency lead to develop space transportation technologies. Within ASTP, under the Spaceliner Investment Area, third generation technologies are being pursued. The Spaceliner Investment Area's primary objective is to mature vehicle technologies to enable substantial increases in the design and operating margins of third generation RLVs (current Space Shuttle is considered the first generation RLV) by incorporating advanced propulsion systems, materials, structures, thermal protection systems, power, and avionics technologies. Advancements in design tools and better characterization of the operational environment will result in reduced design and operational variabilities leading to improvements in margins. Improvements in operational efficiencies will be obtained through the introduction of integrated vehicle health management, operations and range technologies. Investments in these technologies will enable the reduction in the high operational costs associated with today's vehicles by allowing components to operate well below their design points resulting in improved component operating life, reliability, and safety which in turn reduces both maintenance and refurbishment costs. The introduction of advanced technologies may enable horizontal takeoff by significantly reducing the takeoff weight and allowing use of existing infrastructure. This would be a major step toward the goal of airline-like operation. These factors in conjunction with increased flight rates, resulting from reductions in transportation costs, will result in significant improvements of future vehicles. The real-world problem is that resources are limited and technologies need to be prioritized to assure the resources are spent on technologies that provide the highest system level benefits. Toward that end, a systems approach is being taken to determine the benefits of technologies for the Spaceliner Investment Area. Technologies identified to be enabling will be funded. However, the other technologies will be funded based on their system's benefits. Since the final launch system concept will not be decided for many years, several vehicle concepts are being evaluated to determine technology benefits. Not only performance, but also cost and operability are being assessed. This will become an annual process to assess these technologies against their goals and the benefits to various launch systems concepts. The paper describes the system process, tools and concepts used to determine the technology benefits. Preliminary results will be presented along with the current technology investments that are being made by ASTP's Spaceliner Investment Area.

The MAP Autonomous Mission Control System

NASA Technical Reports Server (NTRS)

Breed, Juile; Coyle, Steven; Blahut, Kevin; Dent, Carolyn; Shendock, Robert; Rowe, Roger

2000-01-01

The Microwave Anisotropy Probe (MAP) mission is the second mission in NASA's Office of Space Science low-cost, Medium-class Explorers (MIDEX) program. The Explorers Program is designed to accomplish frequent, low cost, high quality space science investigations utilizing innovative, streamlined, efficient management, design and operations approaches. The MAP spacecraft will produce an accurate full-sky map of the cosmic microwave background temperature fluctuations with high sensitivity and angular resolution. The MAP spacecraft is planned for launch in early 2001, and will be staffed by only single-shift operations. During the rest of the time the spacecraft must be operated autonomously, with personnel available only on an on-call basis. Four (4) innovations will work cooperatively to enable a significant reduction in operations costs for the MAP spacecraft. First, the use of a common ground system for Spacecraft Integration and Test (I&T) as well as Operations. Second, the use of Finite State Modeling for intelligent autonomy. Third, the integration of a graphical planning engine to drive the autonomous systems without an intermediate manual step. And fourth, the ability for distributed operations via Web and pager access.

Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room.

PubMed

LaRoy, Jennifer R; White, Sarah B; Jayakrishnan, Thejus; Dybul, Stephanie; Ungerer, Dirk; Turaga, Kiran; Patel, Parag J

2015-06-01

To compare complications and cost, from a hospital perspective, of chest port insertions performed in an interventional radiology (IR) suite versus in surgery in an operating room (OR). This study was approved by an institutional review board and is HIPAA compliant. Medical records were retrospectively searched on consecutive chest port placement procedures, in the IR suite and the OR, between October 22, 2010 and February 26, 2013, to determine patients' demographic information and chest port-related complications and/or infections. A total of 478 charts were reviewed (age range: 21-85 years; 309 women, 169 men). Univariate and bivariate analyses were performed to identify risk factors associated with an increased complication rate. Cost data on 149 consecutive Medicare outpatients (100 treated in the IR suite; 49 treated in the OR) who had isolated chest port insertions between March 2012 and February 2013 were obtained for both the operative services and pharmacy. Nonparametric tests for heterogeneity were performed using the Kruskal-Wallis method. Early complications occurred in 9.2% (22 of 239) of the IR patients versus 13.4% (32 of 239) of the OR patients. Of the 478 implanted chest ports, 9 placed in IR and 18 placed in surgery required early removal. Infections from the ports placed in IR versus the OR were 0.25 versus 0.18 infections per 1000 catheters, respectively. Overall mean costs for chest port insertion were significantly higher in the OR, for both room and pharmacy costs (P < .0001). Overall average cost to place chest ports in an OR setting was almost twice that of placement in the IR suite. Hospital costs to place a chest port were significantly lower in the IR suite than in the OR, whereas radiology and surgery patients did not show a significantly different rate of complications and/or infections. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Umbilical hernias: the cost of waiting.

PubMed

Strosberg, David S; Pittman, Matthew; Mikami, Dean

2017-02-01

Umbilical hernias are well described in the literature, but its impact on health care is less understood. The purpose of this study was to investigate the effect of non-operative management of umbilical hernias on cost, work absenteeism, and resource utilization. The Truven Health Database, consisting of 279 employers and over 3000 hospitals, was reviewed for all umbilical hernia patients, aged 18-64 who were enrolled in health plans for 12 months prior to surgery and 12 months after surgery. Patients were excluded if they had a recurrence or had been offered a "no surgery" approach within 1 year of the index date. The remaining patients were separated into surgery (open or laparoscopic repair) or no surgery (NS). Post-cost analysis at 90 and 365 days and estimated days off from work were reviewed for each group. The non-surgery cohort had a higher proportion of females and comorbidity index. Adjusted analysis showed significantly higher 90 and 365 costs for the surgery group (p < 0.0001), though the cost difference did decrease over time. NS group had significantly higher estimated days of health-care utilization at both the 90 (1.99 vs. 3.58 p < 0.0001) and 365 (8.69 vs. 11.04 p < 0.0001) day post-index mark. A subgroup analysis demonstrated laparoscopic repair had higher costs compared to open primarily due to higher index procedure costs (p < 0.05). Though the financial costs were found to be higher in the surgery group, the majority of these were due to the surgery itself. Significantly higher days of health-care utilization and estimated days off work were experienced in the NS group. It is our belief that early operative intervention will lead to decreased costs and resource utilization.

Advanced ground station architecture

NASA Technical Reports Server (NTRS)

Zillig, David; Benjamin, Ted

1994-01-01

This paper describes a new station architecture for NASA's Ground Network (GN). The architecture makes efficient use of emerging technologies to provide dramatic reductions in size, operational complexity, and operational and maintenance costs. The architecture, which is based on recent receiver work sponsored by the Office of Space Communications Advanced Systems Program, allows integration of both GN and Space Network (SN) modes of operation in the same electronics system. It is highly configurable through software and the use of charged coupled device (CCD) technology to provide a wide range of operating modes. Moreover, it affords modularity of features which are optional depending on the application. The resulting system incorporates advanced RF, digital, and remote control technology capable of introducing significant operational, performance, and cost benefits to a variety of NASA communications and tracking applications.

Parts Quality Management: Direct Part Marking via Data Matrix Symbols for Mission Assurance

NASA Technical Reports Server (NTRS)

Moss, Chantrice

2013-01-01

A United States Government Accountability Office (GAO) review of twelve NASA programs found widespread parts quality problems contributing to significant cost overruns, schedule delays, and reduced system reliability. Direct part-marking with Data Matrix symbols could significantly improve the quality of inventory control and parts lifecycle management. This paper examines the feasibility of using 15 marking technologies for use in future NASA programs. A structural analysis is based on marked material type, operational environment (e.g., ground, suborbital, orbital), durability of marks, ease of operation, reliability, and affordability. A cost-benefits analysis considers marking technology (data plates, label printing, direct part marking) and marking types (two-dimensional machine-readable, human-readable). Previous NASA parts marking efforts and historical cost data are accounted for, including in-house vs. outsourced marking. Some marking methods are still under development. While this paper focuses on NASA programs, results may be applicable to a variety of industrial environments.

Estimates of outage costs of electricity in Pakistan

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

Ashraf, J.; Sabih, F.

1993-12-31

This article estimates outage costs of electricity for each of the four provinces in Pakistan (Punjab, North-West Frontier Province, Baluchistan, and Sind). The term {open_quotes}power outage{close_quotes} refers to all problems associated with electricity supply, such as voltage drops (brownouts), power failures (blackouts), and load shedding. The most significant of these in Pakistan is load shedding when power supply to different consumers is shut off during different times of the day, especially during peak hours when the pressure on the system is the highest. Power shortages mainly arise during the low-water months when the effective capacity of hydropower plants drops significantly.more » This decline in power supplied by hydro plants cannot be made up by operating thermal power plants because of the limited availability of gas and the high cost of alternative fuels required for the operation of gas turbines.« less

41 CFR 109-27.102-51 - Policy.

Code of Federal Regulations, 2011 CFR

2011-01-01

... operations is a proven cost-effective approach to meeting procurement needs and may be implemented in DOE offices and designated contractors wherever significant cost savings to the Government will result... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Policy. 109-27.102-51...

41 CFR 109-27.102-51 - Policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... operations is a proven cost-effective approach to meeting procurement needs and may be implemented in DOE offices and designated contractors wherever significant cost savings to the Government will result... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Policy. 109-27.102-51...

Upgrade of Compressed Air Control System Reduces Energy Costs at Michelin Tire Plant. Office of Industrial Technologies (OIT) BestPractices Project Case Study

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

Not Available

2002-01-01

This case study highlights the upgraded compressed air system at a Michelin tire manufacturing plant in Spartanburg, South Carolina. The controls upgrade project enabled multiple compressor operation without blow-off, and significantly reduced energy costs.

Money well spent: a comparison of hospital operating margin for laparoscopic and open colectomies.

PubMed

Koopmann, M C; Harms, B A; Heise, C P

2007-10-01

Cost analysis after laparoscopic colectomy has been examined, although reports evaluating the effects of laparoscopy on hospital operating margin are lacking. We compared several cost/revenue measures, including hospital operating margin, between open and laparoscopic colectomies at an academic center. Our cost-accounting database was queried for laparoscopic partial (LPC) and total colectomies (LTC), and open partial (OPC) and total colectomies (OTC) to analyze net revenue, total costs, and total hospital operating margin over a 4-year period. Laparoscopic and open colectomy cases were compared, with mean operating margin as the primary outcome. From July, 2002 through May, 2006, 842 patients were included for analysis with 138 undergoing laparoscopic colectomy. Net revenue was higher in the LTC group compared with open (US dollars 30,300 vs US dollars 26,800 [P = .02]), and lower in the LPC group (US dollars 15,300 vs US dollars 21,300 open [P < .0001]). Total costs were reduced in both the LPC and LTC groups compared with open [US dollars 11,700 vs US dollars 17,600 [P < .0001] and US dollars 18,000 vs US dollars 19,400 [P = .0019], respectively). LPC resulted in a similar HOM (US dollars 3,602) compared with OPC (US dollars 3,647; P = .35). LTC resulted in a higher HOM (US dollars 12,300) compared with OTC (US dollars 7,400; P = .02). LTC generates a significantly higher hospital operating margin than an OTC, although the margins are similar for LPC and OPC.

A 20 Year Lifecycle Study for Launch Facilities at the Kennedy Space Center

NASA Technical Reports Server (NTRS)

Kolody, Mark R.; Li. Wenyan; Hintze, Paul E.; Calle, Luz-Marina

2009-01-01

The lifecycle cost analysis was based on corrosion costs for the Kennedy Space Center's Launch Complexes and Mobile Launch Platforms. The first step in the study involved identifying the relevant assets that would be included. Secondly, the identification and collection of the corrosion control cost data for the selected assets was completed. Corrosion control costs were separated into four categories. The sources of cost included the NASA labor for civil servant personnel directly involved in overseeing and managing corrosion control of the assets, United Space Alliance (USA) contractual requirements for performing planned corrosion control tasks, USA performance of unplanned corrosion control tasks, and Testing and Development. Corrosion control operations performed under USA contractual requirements were the most significant contributors to the total cost of corrosion. The operations include the inspection of the pad, routine maintenance of the pad, medium and large scale blasting and repainting activities, and the repair and replacement of structural metal elements. Cost data was collected from the years between 2001 and 2007. These costs were then extrapolated to future years to calculate the 20 year lifecycle costs.

Assessing administrative costs of mental health and substance abuse services.

PubMed

Broyles, Robert W; Narine, Lutchmie; Robertson, Madeline J

2004-05-01

Increasing competition in the market for mental health and substance abuse MHSA services and the potential to realize significant administrative savings have created an imperative to monitor, evaluate, and control spending on administrative functions. This paper develops a generic model that evaluates spending on administrative personnel by a group of providers. The precision of the model is demonstrated by examining a set of data assembled from five MHSA service providers. The model examines a differential cost construction derived from inter-facility comparisons of administrative expenses. After controlling for the scale of operations, the results enable MHSA programs to control the efficiency of administrative personnel and related rates of compensation. The results indicate that the efficiency of using the administrative complement and the scale of operations represent the lion's share of the total differential cost. The analysis also indicates that a modest improvement in the use of administrative personnel results in substantial cost savings, an increase in the net cash flow derived from operations, an improvement in the fiscal performance of the provider, and a decline in opportunity costs that assume the form of foregone direct patient care.

Space program payload costs and their possible reduction

NASA Technical Reports Server (NTRS)

Vanvleck, E. M.; Deerwester, J. M.; Norman, S. M.; Alton, L. R.

1973-01-01

The possible ways by which NASA payload costs might be reduced in the future were studied. The major historical reasons for payload costs being as they were, and if there are technologies (hard and soft), or criteria for technology advances, that could significantly reduce total costs of payloads were examined. Payload costs are placed in historical context. Some historical cost breakdowns for unmanned NASA payloads are presented to suggest where future cost reductions could be most significant. Space programs of NOAA, DoD and COMSAT are then examined to ascertain if payload reductions have been brought about by the operational (as opposed to developmental) nature of such programs, economies of scale, the ability to rely on previously developed technology, or by differing management structures and attitudes. The potential impact was investigated of NASA aircraft-type management on spacecraft program costs, and some examples relating previous costs associated with aircraft costs on the one hand and manned and unmanned costs on the other are included.

Societal costs in displaced transverse olecranon fractures: using decision analysis tools to find the most cost-effective strategy between tension band wiring and locked plating.

PubMed

Francis, Tittu; Washington, Travis; Srivastava, Karan; Moutzouros, Vasilios; Makhni, Eric C; Hakeos, William

2017-11-01

Tension band wiring (TBW) and locked plating are common treatment options for Mayo IIA olecranon fractures. Clinical trials have shown excellent functional outcomes with both techniques. Although TBW implants are significantly less expensive than a locked olecranon plate, TBW often requires an additional operation for implant removal. To choose the most cost-effective treatment strategy, surgeons must understand how implant costs and return to the operating room influence the most cost-effective strategy. This cost-effective analysis study explored the optimal treatment strategies by using decision analysis tools. An expected-value decision tree was constructed to estimate costs based on the 2 implant choices. Values for critical variables, such as implant removal rate, were obtained from the literature. A Monte Carlo simulation consisting of 100,000 trials was used to incorporate variability in medical costs and implant removal rates. Sensitivity analysis and strategy tables were used to show how different variables influence the most cost-effective strategy. TBW was the most cost-effective strategy, with a cost savings of approximately $1300. TBW was also the dominant strategy by being the most cost-effective solution in 63% of the Monte Carlo trials. Sensitivity analysis identified implant costs for plate fixation and surgical costs for implant removal as the most sensitive parameters influencing the cost-effective strategy. Strategy tables showed the most cost-effective solution as 2 parameters vary simultaneously. TBW is the most cost-effective strategy in treating Mayo IIA olecranon fractures despite a higher rate of return to the operating room. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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

DOE PAGES

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

2017-07-25

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

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

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

Luo, Na; Hong, Tianzhen; Li, Hui

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

Shared use of school facilities with community organizations and afterschool physical activity program participation: a cost-benefit assessment.

PubMed

Kanters, Michael A; Bocarro, Jason N; Filardo, Mary; Edwards, Michael B; McKenzie, Thomas L; Floyd, Myron F

2014-05-01

Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined shared use of middle school facilities, the amount and type of afterschool physical activity programs provided at middle schools together with the costs of operating the facilities. Afterschool programs were assessed for frequency, duration, and type of structured physical activity programs provided and the number of boys and girls in each program. School operating costs were used to calculate a cost per student and cost per building square foot measure. Data were collected at all 30 middle schools in a large school district over 12 months in 2010-2011. Policies that permitted more use of school facilities for community-sponsored programs increased participation in afterschool programs without a significant increase in operating expenses. These results suggest partnerships between schools and other community agencies to share facilities and create new opportunities for afterschool physical activity programs are a promising health promotion strategy. © 2014, American School Health Association.

Design and Development of a Rapid Research, Design, and Development Platform for In-Situ Testing of Tools and Concepts for Trajectory-Based Operations

NASA Technical Reports Server (NTRS)

Underwood, Matthew C.

2017-01-01

To provide justification for equipping a fleet of aircraft with avionics capable of supporting trajectory-based operations, significant flight testing must be accomplished. However, equipping aircraft with these avionics and enabling technologies to communicate the clearances required for trajectory-based operations is cost-challenging using conventional avionics approaches. This paper describes an approach to minimize the costs and risks of flight testing these technologies in-situ, discusses the test-bed platform developed, and highlights results from a proof-of-concept flight test campaign that demonstrates the feasibility and efficiency of this approach.

Five-year results of a randomised controlled trial comparing mobile and fixed bearings in total knee replacement.

PubMed

Breeman, S; Campbell, M K; Dakin, H; Fiddian, N; Fitzpatrick, R; Grant, A; Gray, A; Johnston, L; MacLennan, G S; Morris, R W; Murray, D W

2013-04-01

There is conflicting evidence about the merits of mobile bearings in total knee replacement, partly because most randomised controlled trials (RCTs) have not been adequately powered. We report the results of a multicentre RCT of mobile versus fixed bearings. This was part of the knee arthroplasty trial (KAT), where 539 patients were randomly allocated to mobile or fixed bearings and analysed on an intention-to-treat basis. The primary outcome measure was the Oxford Knee Score (OKS) plus secondary measures including Short Form-12, EuroQol EQ-5D, costs, cost-effectiveness and need for further surgery. There was no significant difference between the groups pre-operatively: mean OKS was 17.18 (sd 7.60) in the mobile-bearing group and 16.49 (sd 7.40) in the fixed-bearing group. At five years mean OKS was 33.19 (sd 16.68) and 33.65 (sd 9.68), respectively. There was no significant difference between trial groups in OKS at five years (-1.12 (95% confidence interval -2.77 to 0.52) or any of the other outcome measures. Furthermore, there was no significant difference in the proportion of patients with knee-related re-operations or in total costs. In this appropriately powered RCT, over the first five years after total knee replacement functional outcomes, re-operation rates and healthcare costs appear to be the same irrespective of whether a mobile or fixed bearing is used.

Nuclear power technology requirements for NASA exploration missions

NASA Technical Reports Server (NTRS)

Bloomfield, Harvey S.

1990-01-01

It is pointed out that future exploration of the moon and Mars will mandate developments in many areas of technology. In particular, major advances will be required in planet surface power systems. Critical nuclear technology challenges that can enable strategic self-sufficiency, acceptable operational costs, and cost-effective space transportation goals for NASA exploration missions have been identified. Critical technologies for surface power systems include stationary and mobile nuclear reactor and radioisotope heat sources coupled to static and dynamic power conversion devices. These technologies can provide dramatic reductions in mass, leading to operational and transportation cost savings. Critical technologies for space transportation systems include nuclear thermal rocket and nuclear electric propulsion options, which present compelling concepts for significantly reducing mass, cost, or travel time required for Earth-Mars transport.

Report on cost/pricing relationships for the space shuttle. [NASA/STS Operations Report

NASA Technical Reports Server (NTRS)

1977-01-01

The operations cost for the shuttle is the basis for developing the user charge policy for the system. The policy contains several elements that are significant to the user and to NASA. It will encourage the full use of the system to the benefits of the U.S. The charge policy will encourage early transition from the expendable launch vehicles to the shuttle and this will result in lower user costs for government as well as commercial users. The relationship between the charge policy and the utilization of the shuttle is critical to the economic efficiency of the system. NASA recognizes the challenging a relationship between pricing the cost of using a reusable space system, and the need to make sure it is re-used often.

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

PubMed

Gupta, Deepak; Haber, Halim

2014-06-01

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

Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

PubMed

Perkowski, Patryk; Rodberg, Leonard

2016-01-01

Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries. © The Author(s) 2015.

Design optimization for cost and quality: The robust design approach

NASA Technical Reports Server (NTRS)

Unal, Resit

1990-01-01

Designing reliable, low cost, and operable space systems has become the key to future space operations. Designing high quality space systems at low cost is an economic and technological challenge to the designer. A systematic and efficient way to meet this challenge is a new method of design optimization for performance, quality, and cost, called Robust Design. Robust Design is an approach for design optimization. It consists of: making system performance insensitive to material and subsystem variation, thus allowing the use of less costly materials and components; making designs less sensitive to the variations in the operating environment, thus improving reliability and reducing operating costs; and using a new structured development process so that engineering time is used most productively. The objective in Robust Design is to select the best combination of controllable design parameters so that the system is most robust to uncontrollable noise factors. The robust design methodology uses a mathematical tool called an orthogonal array, from design of experiments theory, to study a large number of decision variables with a significantly small number of experiments. Robust design also uses a statistical measure of performance, called a signal-to-noise ratio, from electrical control theory, to evaluate the level of performance and the effect of noise factors. The purpose is to investigate the Robust Design methodology for improving quality and cost, demonstrate its application by the use of an example, and suggest its use as an integral part of space system design process.

Essential and non-essential paediatric surgery: implications for the future delivery of state health care in the UK.

PubMed

Farrelly, Paul J; Losty, Paul D

2015-09-01

Delivery of health care in the UK faces enormous challenges with the Department of Health driving significant financial cost savings to ensure viability of public health services. We have analysed and modelled the concept of 'essential' and 'non-essential' paediatric surgery linked to the delivery of children's surgery in the NHS in England. Operation codes for surgical operations in newborns, children and adolescents were identified and Healthcare Resource Group tariffs-£Stg matched. Operations were designated as 'essential' or 'non-essential' based on the criteria-(1) life saving-neonatal surgery, emergency general surgery of childhood, cancer surgery; (2) debility if uncorrected; (3) aesthetics and (4) culture/attitude. Hospital Episode Statistics (HES) data were accessed and sampled for the total number of paediatric surgical operations-(age range 0-14 years) performed in NHS hospitals from 2009 to 2010. Annual costs (£) of both 'essential' and 'non-essential' operations were then calculated. The commonest 'essential' operations performed in children and adolescents in the year 2009-2010 was appendicectomy at a cost of over £51 million pounds. Costs of performing a selection of 'non-essential' paediatric surgery operations were >£14 million pounds/year. The NHs funds for example almost 11,000 paediatric circumcisions annually at a cost of >£8 million pounds-50% are performed for non-therapeutic reasons. Surgeons must engage and work actively with health care systems to ensure diminishing financial resources prioritise 'essential' operations for children. Commissioners must embrace evidence-based surgery. 'Essential' and 'non-essential' surgery has wide implications for the sustainability of the NHS and concepts herein developed can be applied to nations worldwide.

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

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

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

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

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

PubMed

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

2002-10-01

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

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

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

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

Benefits of barrier fuel on fuel cycle economics

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

Crowther, R.L.; Kunz, C.L.

1988-01-01

Barrier fuel rod cladding was developed to eliminate fuel rod failures from pellet/cladding stress/corrosion interaction and to eliminate the associated need to restrict the rate at which fuel rod power can be increased. The performance of barrier cladding has been demonstrated through extensive testing and through production application to many boiling water reactors (BWRs). Power reactor data have shown that barrier fuel rod cladding has a significant beneficial effect on plant capacity factor and plant operating costs and significantly increases fuel reliability. Independent of the fuel reliability benefit, it is less obvious that barrier fuel has a beneficial effect ofmore » fuel cycle costs, since barrier cladding is more costly to fabricate. Evaluations, measurements, and development activities, however, have shown that the fuel cycle cost benefits of barrier fuel are large. This paper is a summary of development activities that have shown that application of barrier fuel significantly reduces BWR fuel cycle costs.« less

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

PubMed

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

2018-05-18

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

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

PubMed

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

2017-04-10

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

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

NASA Astrophysics Data System (ADS)

Swartwout, Michael Alden

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

Unmanned Aerial Vehicles unique cost estimating requirements

NASA Astrophysics Data System (ADS)

Malone, P.; Apgar, H.; Stukes, S.; Sterk, S.

Unmanned Aerial Vehicles (UAVs), also referred to as drones, are aerial platforms that fly without a human pilot onboard. UAVs are controlled autonomously by a computer in the vehicle or under the remote control of a pilot stationed at a fixed ground location. There are a wide variety of drone shapes, sizes, configurations, complexities, and characteristics. Use of these devices by the Department of Defense (DoD), NASA, civil and commercial organizations continues to grow. UAVs are commonly used for intelligence, surveillance, reconnaissance (ISR). They are also use for combat operations, and civil applications, such as firefighting, non-military security work, surveillance of infrastructure (e.g. pipelines, power lines and country borders). UAVs are often preferred for missions that require sustained persistence (over 4 hours in duration), or are “ too dangerous, dull or dirty” for manned aircraft. Moreover, they can offer significant acquisition and operations cost savings over traditional manned aircraft. Because of these unique characteristics and missions, UAV estimates require some unique estimating methods. This paper describes a framework for estimating UAV systems total ownership cost including hardware components, software design, and operations. The challenge of collecting data, testing the sensitivities of cost drivers, and creating cost estimating relationships (CERs) for each key work breakdown structure (WBS) element is discussed. The autonomous operation of UAVs is especially challenging from a software perspective.

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.

Effects of Agent Transparency on Multi-Robot Management Effectiveness

DTIC Science & Technology

2015-09-01

capacity was found to be a significant predictor of participants’ trust in the agent. Individual differences in spatial ability accounted for...Another concern regarding autonomous systems is operator workload, which is the cost of performing a task that reduces an individual’s ability to complete...more elaborate and costly strategy that cost additional time (Clark et al. 2011). We hypothesize, therefore, that action GE will be associated with

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

PubMed

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

2016-10-01

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

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

PubMed

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

2011-03-01

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

Carbon dioxide capture from atmospheric air using sodium hydroxide spray.

PubMed

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

2008-04-15

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

Report of the Space Shuttle Management Independent Review Team

NASA Technical Reports Server (NTRS)

1995-01-01

At the request of the NASA Administrator a team was formed to review the Space Shuttle Program and propose a new management system that could significantly reduce operating costs. Composed of a group of people with broad and extensive experience in spaceflight and related areas, the team received briefings from the NASA organizations and most of the supporting contractors involved in the Shuttle Program. In addition, a number of chief executives from the supporting contractors provided advice and suggestions. The team found that the present management system has functioned reasonably well despite its diffuse structure. The team also determined that the shuttle has become a mature and reliable system, and--in terms of a manned rocket-propelled space launch system--is about as safe as today's technology will provide. In addition, NASA has reduced shuttle operating costs by about 25 percent over the past 3 years. The program, however, remains in a quasi-development mode and yearly costs remain higher than required. Given the current NASA-contractor structure and incentives, it is difficult to establish cost reduction as a primary goal and implement changes to achieve efficiencies. As a result, the team sought to create a management structure and associated environment that enables and motivates the Program to further reduce operational costs. Accordingly, the review team concluded that the NASA Space Shuttle Program should (1) establish a clear set of program goals, placing a greater emphasis on cost-efficient operations and user-friendly payload integration; (2) redefine the management structure, separating development and operations and disengaging NASA from the daily operation of the space shuttle; and (3) provide the necessary environment and conditions within the program to pursue these goals.

Report of the Space Shuttle Management Independent Review Team

NASA Astrophysics Data System (ADS)

1995-02-01

At the request of the NASA Administrator a team was formed to review the Space Shuttle Program and propose a new management system that could significantly reduce operating costs. Composed of a group of people with broad and extensive experience in spaceflight and related areas, the team received briefings from the NASA organizations and most of the supporting contractors involved in the Shuttle Program. In addition, a number of chief executives from the supporting contractors provided advice and suggestions. The team found that the present management system has functioned reasonably well despite its diffuse structure. The team also determined that the shuttle has become a mature and reliable system, and--in terms of a manned rocket-propelled space launch system--is about as safe as today's technology will provide. In addition, NASA has reduced shuttle operating costs by about 25 percent over the past 3 years. The program, however, remains in a quasi-development mode and yearly costs remain higher than required. Given the current NASA-contractor structure and incentives, it is difficult to establish cost reduction as a primary goal and implement changes to achieve efficiencies. As a result, the team sought to create a management structure and associated environment that enables and motivates the Program to further reduce operational costs. Accordingly, the review team concluded that the NASA Space Shuttle Program should (1) establish a clear set of program goals, placing a greater emphasis on cost-efficient operations and user-friendly payload integration; (2) redefine the management structure, separating development and operations and disengaging NASA from the daily operation of the space shuttle; and (3) provide the necessary environment and conditions within the program to pursue these goals.

Preliminary Findings of the South Africa Power System Capacity Expansion and Operational Modelling Study: Preprint

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

Reber, Timothy J; Chartan, Erol Kevin; Brinkman, Gregory L

Wind and solar power contract prices have recently become cheaper than many conventional new-build alternatives in South Africa and trends suggest a continued increase in the share of variable renewable energy (vRE) on South Africa's power system with coal technology seeing the greatest reduction in capacity, see 'Figure 6: Percentage share by Installed Capacity (MW)' in [1]. Hence it is essential to perform a state-of-the-art grid integration study examining the effects of these high penetrations of vRE on South Africa's power system. Under the 21st Century Power Partnership (21CPP), funded by the U.S. Department of Energy, the National Renewable Energymore » Laboratory (NREL) has significantly augmented existing models of the South African power system to investigate future vRE scenarios. NREL, in collaboration with Eskom's Planning Department, further developed, tested and ran a combined capacity expansion and operational model of the South African power system including spatially disaggregated detail and geographical representation of system resources. New software to visualize and interpret modelling outputs has been developed, and scenario analysis of stepwise vRE build targets reveals new insight into associated planning and operational impacts and costs. The model, built using PLEXOS, is split into two components, firstly a capacity expansion model and secondly a unit commitment and economic dispatch model. The capacity expansion model optimizes new generation decisions to achieve the lowest cost, with a full understanding of capital cost and an approximated understanding of operational costs. The operational model has a greater set of detailed operational constraints and is run at daily resolutions. Both are run from 2017 through 2050. This investigation suggests that running both models in tandem may be the most effective means to plan the least cost South African power system as build plans seen to be more expensive than optimal by the capacity expansion model can produce greater operational cost savings seen only in the operational model.« less

Rethinking chiller plant design

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

Meckler, M.

1998-07-01

While most refrigeration chillers operate today on electricity, the use of natural gas is becoming an increasingly attractive alternative. This is largely because electricity does not use energy very efficiency (because of transmission and combustion fuel losses), high demand charges, and the high incremental cost of electricity to operate chillers. The use of gas engine-driven chillers eliminates the high incremental cost of electricity. Additionally, gas engine-driven systems can operate with COPs up to 1.8 and, therefore, are economically viable alternatives. Recent advances in gas engine-driven and DFA absorption chillers, and in commercially viable solid and liquid desiccant-cooling systems, suggest amore » bright future for the gas industry. The use of such equipment in conjunction with or in place of commercially available electrical-powered alternatives can significantly impact demand-side management savings for utility ratepayers in the short run and provide significant hybrid opportunities for deregulated markets in the intermediate to long term.« less

Rethinking chiller plant design

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

Meckler, M.

1998-01-01

While most refrigeration chillers operate today on electricity, the use of natural gas is becoming an increasingly attractive alternative. This is largely because electricity does not use energy very efficiently (due to transmission and combustion fuel losses), high demand charges, and the high incremental cost of electricity to operate chillers. The use of gas engine-driven chillers eliminates the high incremental cost of electricity. Additionally, gas engine-driven systems can operate with COPs up to 1.8 and therefore are economically viable alternatives. Recent advances in gas engine-driven and direct-fired absorption chillers and in commercially viable solid- and liquid-desiccant cooling systems suggest amore » bright future for the gas industry. The use of such equipment in conjunction with or in place of commercially available electrical-powered alternatives can significantly impact demand-side management savings for utility ratepayers in the short run and provide significant hybrid opportunities for deregulated markets in the intermediate to long term.« less

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

PubMed

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

2007-05-01

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

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

PubMed

Olusesi, A D; Oyeniran, O

2017-05-01

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

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

PubMed

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

2015-03-01

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

The reusable launch vehicle technology program

NASA Astrophysics Data System (ADS)

Cook, S.

Today's launch systems have major shortcomings that will increase in significance in the future, and thus are principal drivers for seeking major improvements in space transportation. They are too costly; insufficiently reliable, safe, and operable; and increasingly losing market share to international competition. For the United States to continue its leadership in the human exploration and wide ranging utilization of space, the first order of business must be to achieve low cost, reliable transportatin to Earth orbit. NASA's Access to Space Study, in 1993, recommended the development of a fully reusable single-stage-to-orbit (SSTO) rocket vehicle as an Agency goal. The goal of the Reusable Launch Vehicle (RLV) technology program is to mature the technologies essential for a next-generation reusable launch system capable of reliably serving National space transportation needs at substantially reduced costs. The primary objectives of the RLV technology program are to (1) mature the technologies required for the next-generation system, (2) demonstrate the capability to achieve low development and operational cost, and rapid launch turnaround times and (3) reduce business and technical risks to encourage significant private investment in the commercial development and operation of the next-generation system. Developing and demonstrating the technologies required for a Single Stage to Orbit (SSTO) rocket is a focus of the program becuase past studies indicate that it has the best potential for achieving the lowest space access cost while acting as an RLV technology driver (since it also encompasses the technology requirements of reusable rocket vehicles in general).

The reusable launch vehicle technology program

NASA Technical Reports Server (NTRS)

Cook, S.

1995-01-01

Today's launch systems have major shortcomings that will increase in significance in the future, and thus are principal drivers for seeking major improvements in space transportation. They are too costly; insufficiently reliable, safe, and operable; and increasingly losing market share to international competition. For the United States to continue its leadership in the human exploration and wide ranging utilization of space, the first order of business must be to achieve low cost, reliable transportatin to Earth orbit. NASA's Access to Space Study, in 1993, recommended the development of a fully reusable single-stage-to-orbit (SSTO) rocket vehicle as an Agency goal. The goal of the Reusable Launch Vehicle (RLV) technology program is to mature the technologies essential for a next-generation reusable launch system capable of reliably serving National space transportation needs at substantially reduced costs. The primary objectives of the RLV technology program are to (1) mature the technologies required for the next-generation system, (2) demonstrate the capability to achieve low development and operational cost, and rapid launch turnaround times and (3) reduce business and technical risks to encourage significant private investment in the commercial development and operation of the next-generation system. Developing and demonstrating the technologies required for a Single Stage to Orbit (SSTO) rocket is a focus of the program becuase past studies indicate that it has the best potential for achieving the lowest space access cost while acting as an RLV technology driver (since it also encompasses the technology requirements of reusable rocket vehicles in general).

32 CFR 179.7 - Sequencing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... and social factors. (3) Economic factors, including economic considerations pertaining to... alternatives to responses that entail significant capital investments, a lengthy period of operation, or costly...

32 CFR 179.7 - Sequencing.

Code of Federal Regulations, 2011 CFR

2011-07-01

... and social factors. (3) Economic factors, including economic considerations pertaining to... alternatives to responses that entail significant capital investments, a lengthy period of operation, or costly...

Launch Vehicle Production and Operations Cost Metrics

NASA Technical Reports Server (NTRS)

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

2014-01-01

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

Modular Biopower System Providing Combined Heat and Power for DoD Installations

DTIC Science & Technology

2013-12-01

Cycle Cost evaluation using the experimental results of the 6-month field demonstration and the system’s projected cost and performance for the...34 5.6 SAMPLING RESULTS ...premises, which resulted in a significant program delay. After a short period of operation, the custom-designed engine developed mechanical

No Strings Attached

ERIC Educational Resources Information Center

Drozdowski, Mark J.

2008-01-01

Everyone knows it takes money to make money (although not necessarily to earn it), and that certainly applies to development departments. The cost of raising money can be significant; even the most streamlined operations spend about a dime to raise a dollar, and most spend closer to a quarter. For some, the cost is downright embarrassing. It…

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

PubMed

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

2012-05-01

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

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

Bickford, D.F.

During the first two years of radioactive operation of the Defense Waste Processing Facility process, several areas for improvement in melter design were identified. Due to the need for a process that allows continuous melter operation, the down time associated with disruption to melter operation and pouring has significant cost impact. A major objective of this task is to address performance limitations and deficiencies identified by the user.

Unit Cost of Medical Services at Different Hospitals in India

PubMed Central

Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

2013-01-01

Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates under government-sponsored insurance schemes. PMID:23936088

Propensity-matched, longitudinal outcomes analysis of complications and cost: comparing abdominal free flaps and implant-based breast reconstruction.

PubMed

Fischer, John P; Wes, Ari M; Nelson, Jonas A; Basta, Marten; Rohrbach, Jeffrey I; Wu, Liza C; Serletti, Joseph M; Kovach, Stephen J

2014-08-01

Choosing a breast reconstructive modality after mastectomy is an important step in the reconstructive process. The authors hypothesized that autologous tissue is associated with a greater success rate and cost efficacy over time, relative to implant reconstruction. A retrospective review was performed of patients undergoing free tissue (FF) transfer and expander implant (E/I) reconstruction between 2005 and 2011. Variables evaluated included comorbidities, surgical timing, complications, overall outcomes, unplanned reoperations, and costs. A propensity-matching technique was used to account for the nonrandomized selection of modality. A total of 310 propensity-matched patients underwent 499 reconstructions. No statistically significant differences in preoperative variables were noted between propensity-matched cohorts. Operative characteristics were similar between FF and E/I reconstructions. The E/I reconstruction was associated with a significantly higher rate of reconstructive failure (5.6% vs 1.2%, p < 0.001). Expander implant reconstructions were associated with higher rates of seroma (p = 0.009) and lower rates of medical complications (p = 0.02), but overall significantly higher rates of unplanned operations (15.5% vs 5.8%, p = 0.002). The total cost of reconstruction did not differ significantly between groups ($23,120.49 ± $6,969.56 vs $22,739.91 ± $9,727.79, p = 0.060), but E/I reconstruction was associated with higher total cost for secondary procedures ($10,157.89 ± $8,741.77 vs $3,200.71 ± $4,780.64, p < 0.0001) and a higher cost of unplanned revisions over time (p < 0.05). Our matched outcomes analysis does demonstrate a higher overall, 2-year success rate using FF reconstruction and a significantly lower rate of unplanned surgical revisions and cost. Although autologous reconstruction is not ideal for every patient, these findings can be used to enhance preoperative discussions when choosing a reconstructive modality. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Single-incision laparoscopic cholecystectomy: a cost comparison.

PubMed

Love, Katie M; Durham, Christopher A; Meara, Michael P; Mays, Ashley C; Bower, Curtis E

2011-05-01

Single-incision laparoscopic cholecystectomy (SILC) should not cost more or less than traditional laparoscopic cholecystectomy (LC). Retrospective cost data were collected from the accounting records of a single institution. A direct comparison of LC and SILC was conducted. Data on the SILC cases converted to LC were included. The total operating room (OR) cost (actual cost to the hospital for equipment, time, and personnel) and the total OR charges (total derived from the OR cost plus a margin to cover overhead costs beyond material costs) were examined. The total hospital charges (OR charges plus hospital charges accrued in the perioperative period) also were included. Descriptive statistics were used to analyze the data, with p values less than 0.05 considered statistically significant. Over a period of 19 months, 116 cases of minimally invasive cholecystectomy were evaluated. Of the 116 patients, 48 underwent LC during the first half of that period, and 68 patients underwent SILC during the second half of that period. Nine of the single-incision procedures were converted to traditional LC, for a 13% conversion rate. The groups were well matched from a demographics standpoint, with no significant differences in age, gender, body mass index (BMI), diagnoses, American Society of Anesthesiology (ASA) class, or payment. Comparison of all attempted SILCs, including those converted, with all LCs showed no significant difference in cost category totals. A significant difference among all cost variables was found when SILCs were compared with SILCs that required conversion to LC. A significant difference among the cost variables also was found when LCs were compared with converted SILCs. The cost for SILC did not differ significantly from that for LC when standard materials were used and the duration of the procedure was considered. Converted cases were significantly more expensive than completed SILC and LC cases.

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

PubMed

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

2014-06-01

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

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

PubMed

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

2018-01-01

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

Hospital costs associated with smoking in veterans undergoing general surgery.

PubMed

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

2012-06-01

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

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.

Energy Efficient Engine Program: Technology Benefit/Cost Study, Volume II

NASA Technical Reports Server (NTRS)

Gray, D. E.; Gardner, W. B.

1983-01-01

The Benefit/Cost Study portion of the NASA-sponsored Energy Efficient Engine Component Development and Integration program was successful in achieving its objectives: identification of air transport propulsion system technology requirements for the years 2000 and 2010, and formulation of programs for developing these technologies. It is projected that the advanced technologies identified, when developed to a state of readiness, will provide future commercial and military turbofan engines with significant savings in fuel consumption and related operating costs. These benefits are significant and far from exhausted. The potential savings translate into billions of dollars in annual savings for the airlines. Analyses indicate that a significant portion of the overall savings is attributed to aerodynamic and structure advancements. Another important consideration in acquiring these benefits is developing a viable reference technology base that will permit engines to operate at substantially higher overall pressure ratios and bypass ratios. Results have pointed the direction for future research and a comprehensive program plan for achieving this was formulated. The next major step is initiating the program effort that will convert the advanced technologies into the expected benefits.

Life sciences payload definition and integration study. Volume 4: Appendix, costs, and data management requirements of the dedicated 30-day laboratory. [carry-on laboratory for Spacelab

NASA Technical Reports Server (NTRS)

1974-01-01

The results of the updated 30-day life sciences dedicated laboratory scheduling and costing activities are documented, and the 'low cost' methodology used to establish individual equipment item costs is explained in terms of its allowances for equipment that is commerical off-the-shelf, modified commercial, and laboratory prototype; a method which significantly lowers program costs. The costs generated include estimates for non-recurring development, recurring production, and recurring operations costs. A cost for a biomedical emphasis laboratory and a Delta cost to provide a bioscience and technology laboratory were also generated. All cost reported are commensurate with the design and schedule definitions available.

Development of an activity-based costing model to evaluate physician office practice profitability.

PubMed

Dugel, Pravin U; Tong, Kuo Bianchini

2011-01-01

Newer treatment regimens for age-related macular degeneration have significantly affected traditional and non-traditional retinal services across all types of practice settings around the country as they seek to find a balance among delivering best patient care, keeping operating costs under control, and maintaining profitability. A systematic retrospective review of a multi-city, multi-physician retinal practice's accounting system to obtain data on revenues, expenses, and profit. Data reviewed were from practice management systems to obtain claims level data on clinical procedures across 7 primary activity centers: non-laser surgery, laser surgery, office visits, optical coherence tomography (OCT), non-OCT diagnostics, drugs and drug injections, and research. All treated patients from a retina practice from January 1, 2005, to December 31, 2007. Retrospective claims data review from a multi-physician retina practice detailing Current Procedural Terminology and Healthcare Common Procedure Coding System procedures performed and billed, submitted charges, allowed charges, and net collections. Analyses were performed by an outside firm and verified by a risk advisory firm. Identifying practice efficiencies/inefficiencies as they relate to patient care. An elaborate analysis using activity-based costing (ABC) showed that increased office visits and OCT and non-OCT diagnostics had a significant negative impact on the practice's profit margins, whereas surgical procedures contributed to the majority of the practice's profit margins because of the lower operating costs associated with surgery. The practice was able to accommodate the demand in patient volume, medical retina services, and medical imaging with the advent of anti-vascular endothelial growth factor therapy and realized a seismic shift in operating costs. The practice attempted to deliver state-of-the-art patient care in a cost-effective manner, yet underwent a significant decline in its financial health. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Challenges and lessons learned in the application of autonomy to space operations

NASA Technical Reports Server (NTRS)

Forrest, David J.; Statman, Joseph I.

2001-01-01

NASA's Space Operations Management Office (SOMO) is working toward a goal of providing an integrated infrastructure of mission and data services for space missions undertaken by NASA enterprises. A significant portion of this effort is focused on reducing the cost of these services. We are interested in the potential of autonomy to reduce operations costs. Some attempts have already been made to apply autonomy and automation in these areas in the past with varying degrees of success. We present brief case histories and the lessons inferred from them. Combining this past experience with anticipated future needs, we attempt to clarify the challenges that must be met in order to realize the benefits of autonomy.

Conceptual design study of advanced acoustic composite nacelle. [for achieving reductions in community noise and operating expense

NASA Technical Reports Server (NTRS)

Goodall, R. G.; Painter, G. W.

1975-01-01

Conceptual nacelle designs for wide-bodied and for advanced-technology transports were studied with the objective of achieving significant reductions in community noise with minimum penalties in airplane weight, cost, and in operating expense by the application of advanced composite materials to nacelle structure and sound suppression elements. Nacelle concepts using advanced liners, annular splitters, radial splitters, translating centerbody inlets, and mixed-flow nozzles were evaluated and a preferred concept selected. A preliminary design study of the selected concept, a mixed flow nacelle with extended inlet and no splitters, was conducted and the effects on noise, direct operating cost, and return on investment determined.

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

NASA Technical Reports Server (NTRS)

Remer, D. S.

1977-01-01

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

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

PubMed

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

2015-12-01

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

Cost-Effective Telemetry and Command Ground Systems Automation Strategy for the Soil Moisture Active Passive (SMAP) Mission

NASA Technical Reports Server (NTRS)

Choi, Josh; Sanders, Antonio

2012-01-01

Soil Moisture Active Passive (SMAP) is an Earth-orbiting, remote-sensing NASA mission slated for launch in 2014. The ground data system (GDS) being developed for SMAP is composed of many heterogeneous subsystems, ranging from those that support planning and sequencing to those used for real-time operations, and even further to those that enable science data exchange. A full end-to-end automation of the GDS may result in cost savings during mission operations, but it would require a significant upfront investment to develop such a comprehensive automation. As demonstrated by the Jason-1 and Wide-field Infrared Survey Explorer (WISE) missions, a measure of "lights-out" automation for routine, orbital pass, ground operations can still reduce mission costs through smaller staffing of operators and limiting their working hours. The challenge, then, for the SMAP GDS engineering team, is to formulate an automated operations strategy--and corresponding system architecture -- to minimize operator intervention during routine operations, while balancing the development costs associated with the scope and complexity of automation. This paper discusses the automated operations approach being developed for the SMAP GDS. The focus is on automating the activities involved in routine passes, which limits the scope to real-time operations. A key subsystem of the SMAP GDS -- NASA's AMMOS Mission Data Processing and Control System (AMPCS) -- provides a set of capabilities that enable such automation. Also discussed are the lights-out pass automations of the Jason-1 and WISE missions and how they informed the automation strategy for SMAP. The paper aims to provide insights into what is necessary in automating the GDS operations for Earth satellite missions.

Cost-Effective Telemetry and Command Ground Systems Automation Strategy for the Soil Moisture Active Passive (SMAP) Mission

NASA Technical Reports Server (NTRS)

Choi, Joshua S.; Sanders, Antonio L.

2012-01-01

Soil Moisture Active Passive (SMAP) is an Earth-orbiting, remote-sensing NASA mission slated for launch in 2014.[double dagger] The ground data system (GDS) being developed for SMAP is composed of many heterogeneous subsystems, ranging from those that support planning and sequencing to those used for real-time operations, and even further to those that enable science data exchange. A full end-to-end automation of the GDS may result in cost savings during mission operations, but it would require a significant upfront investment to develop such comprehensive automation. As demonstrated by the Jason-1 and Wide-field Infrared Survey Explorer (WISE) missions, a measure of "lights-out" automation for routine, orbital pass ground operations can still reduce mission cost through smaller staffing of operators and limited work hours. The challenge, then, for the SMAP GDS engineering team is to formulate an automated operations strategy--and corresponding system architecture--to minimize operator intervention during operations, while balancing the development cost associated with the scope and complexity of automation. This paper discusses the automated operations approach being developed for the SMAP GDS. The focus is on automating the activities involved in routine passes, which limits the scope to real-time operations. A key subsystem of the SMAP GDS--NASA's AMMOS Mission Data Processing and Control System (AMPCS)--provides a set of capabilities that enable such automation. Also discussed are the lights-out pass automations of the Jason-1 and WISE missions and how they informed the automation strategy for SMAP. The paper aims to provide insights into what is necessary in automating the GDS operations for Earth satellite missions.

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

DTIC Science & Technology

1994-09-01

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

Integrated mission management operations

NASA Technical Reports Server (NTRS)

1971-01-01

Operations required to launch a modular space station and to provides sustaining ground operations for support of that orbiting station throughout its 10 year mission are studied. A baseline, incrementally manned program and attendent experiment program options are derived. In addition, features of the program that significantly effect initial development and early operating costs are identified, and their impact on the program is assessed. A preliminary design of the approved modular space station configuration is formulated.

More Fight-Less Fuel: Reducing Fuel Burn through Ground Process Improvement

DTIC Science & Technology

2013-06-01

These joint government and commercial air operations management suites are fast, accurate, and offer many of 33 same tools as SPADE. However, the U.S...passing hour of the day. Simulating the operations at an airfield is similar to a host of related operations management problems including restaurant...flight line may yield significant fuel and cost reductions. Focusing on the efficient use of ground resources through air operations management in a

Crack detection on wind turbine blades in an operating environment using vibro-acoustic modulation technique

NASA Astrophysics Data System (ADS)

Kim, S.; Adams, D. E.; Sohn, H.

2013-01-01

As the wind power industry has grown rapidly in the recent decade, maintenance costs have become a significant concern. Due to the high repair costs for wind turbine blades, it is especially important to detect initial blade defects before they become structural failures leading to other potential failures in the tower or nacelle. This research presents a method of detecting cracks on wind turbine blades using the Vibo-Acoustic Modulation technique. Using Vibro-Acoustic Modulation, a crack detection test is conducted on a WHISPER 100 wind turbine in its operating environment. Wind turbines provide the ideal conditions in which to utilize Vibro-Acoustic Modulation because wind turbines experience large structural vibrations. The structural vibration of the wind turbine balde was used as a pumping signal and a PZT was used to generate the probing signal. Because the non-linear portion of the dynamic response is more sensitive to the presence of a crack than the environmental conditions or operating loads, the Vibro-Acoustic Modulation technique can provide a robust structural health monitoring approach for wind turbines. Structural health monitoring can significantly reduce maintenance costs when paired with predictive modeling to minimize unscheduled maintenance.

Cost-effectiveness of two operational models at industrial wastewater treatment plants in China: a case study in Shengze town, Suzhou City.

PubMed

Yuan, Zengwei; Jiang, Weili; Bi, Jun

2010-10-01

The widespread illegal discharge of industrial wastewater in China has posed significant challenges to the effective management of industrial wastewater treatment plants (IWTPs) and caused or exacerbated critical social issues such as trans-boundary environmental pollution. This study examines two operational strategies, decentralized model and an innovative integrated model, that have been used in the industrial town of Shengze (located in Suzhou City) over the past two decades at IWTPs handling wastewater from the city's dyeing industry. Our cost-effectiveness analysis shows that, although the operational cost of IWTPs under the integrated model is higher than under the original decentralized model, the integrated model has significantly improved IWTP performance and effectively reduced illegal discharge of industrial wastewater. As a result, the number of reported incidents of unacceptable pollution in local receiving water bodies had declined from 13 in 2000-1 in 2008. Key factors contributing to the success of the innovative integrated model are strong support from municipal and provincial leaders, mandatory ownership transfer of IWTPs to a centralized management body, strong financial incentives for proper plant management, and geographically-clustered IWTPs. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Acute pavement burns: a unique subset of burn injuries: a five-year review of resource use and cost impact.

PubMed

Silver, Andrew G; Dunford, Gerrit M; Zamboni, William A; Baynosa, Richard C

2015-01-01

This study focuses on the hospital care of a rare subset of burn injuries caused by contact with environmentally heated pavement, to further understand the required use of resources. This article aims to show that pavement burns are typically more severe than their flame/scald counterparts. A retrospective review of patients admitted to the burn center with injuries suffered from contact with hot pavement was performed. Patients were stratified on the presence or absence of altered mental status (AMS) and additional inciting factors. A representative sample of similarly sized flame and scald wounds treated in the same time period was compiled for comparison. Those with pavement burns had a significantly greater requirement for operative intervention, repetitive debridements, overall cost/percent burned, and lengthier hospital stays than those with flame/scald burns. Pavement burn victims with AMS were significantly more likely to require an operation, a greater cost/percent burned, and longer hospital stays than those without AMS. Pavement burns are significantly worse than similarly sized scald/flame burns with regards to length of stay and total hospital costs, and the necessity of initial and repetitive operative intervention. These discrepancies are even greater in patients with AMS as a concomitant inciting factor. It is apparent that these wounds often continue to deepen during a patient's stay, likely because of continued pressure on the wounds while recumbent. As such, this article highly recommends pressure off-loading beds and more aggressive debridement in the treatment of these unique injuries.

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

PubMed

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

2011-01-01

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

Space Station Freedom operations costs

NASA Technical Reports Server (NTRS)

Accola, Anne L.; Williams, Gregory J.

1988-01-01

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

[Is the stapled suture in visceral surgery still justified? A prospective controlled, randomized study of cost effectiveness of manual and stapler suture].

PubMed

Izbicki, J R; Gawad, K A; Quirrenbach, S; Hosch, S B; Breid, V; Knoefel, W T; Küpper, H U; Broelsch, C E

1998-07-01

Hospitals are facing increasing economic pressure. It therefore seems necessary to evaluate the efficiency and effectiveness of medical or surgical interventions. In this study 324 anastomoses (167 stapled and 157 hand-sewn) were performed after randomization during 200 elective operations [20.5% gastrectomies, 14% gastric resections (Billroth II), 15% Whipple's procedures, 4% segmental colonic resections, 18% right-sided hemicolectomies, 4% left-sided hemicolectomies, 22% sigmoid- or anterior rectal resections, 2.5% total colectomies with pouch-anal anastomoses] in 200 patients. Postoperative motility (time to full oral diet, time with naso-gastric tube) and hospitalization were comparable in both groups. Anastomotic insufficiency was observed in 2.1% of all patients, five after stapled and two after hand-sewn anastomoses. Hospital mortality was 1.5%. All stapled anastomoses were performed significantly (P < 0.001) faster. However, the cost of material for these anastomoses was significantly (P < 0.001) higher, resulting in significantly higher total costs for reconstruction. The time saving for the reconstruction did not influence the total operative time (except for stapled gastrectomy). Therefore, all operations with stapled reconstruction were more expensive than those with sutured reconstruction. The difference was significant for the gastrectomy (P < 0.01), colonic resection (P < 0.01) and sigmoid and rectal resection (P < 0.001) groups. Stapled and sutured anastomoses are equally effective. Stapled anastomoses are not efficient, however, and should be reserved for individual indications.

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

NASA Technical Reports Server (NTRS)

Remer, D. S.

1977-01-01

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

Theoretical and experimental researches on the operating costs of a wastewater treatment plant

NASA Astrophysics Data System (ADS)

Panaitescu, M.; Panaitescu, F.-V.; Anton, I.-A.

2015-11-01

Purpose of the work: The total cost of a sewage plants is often determined by the present value method. All of the annual operating costs for each process are converted to the value of today's correspondence and added to the costs of investment for each process, which leads to getting the current net value. The operating costs of the sewage plants are subdivided, in general, in the premises of the investment and operating costs. The latter can be stable (normal operation and maintenance, the establishment of power) or variables (chemical and power sludge treatment and disposal, of effluent charges). For the purpose of evaluating the preliminary costs so that an installation can choose between different alternatives in an incipient phase of a project, can be used cost functions. In this paper will be calculated the operational cost to make several scenarios in order to optimize its. Total operational cost (fixed and variable) is dependent global parameters of wastewater treatment plant. Research and methodology: The wastewater treatment plant costs are subdivided in investment and operating costs. We can use different cost functions to estimate fixed and variable operating costs. In this study we have used the statistical formulas for cost functions. The method which was applied to study the impact of the influent characteristics on the costs is economic analysis. Optimization of plant design consist in firstly, to assess the ability of the smallest design to treat the maximum loading rates to a given effluent quality and, secondly, to compare the cost of the two alternatives for average and maximum loading rates. Results: In this paper we obtained the statistical values for the investment cost functions, operational fixed costs and operational variable costs for wastewater treatment plant and its graphical representations. All costs were compared to the net values. Finally we observe that it is more economical to build a larger plant, especially if maximum loading rates are reached. The actual target of operational management is to directly implement the presented cost functions in a software tool, in which the design of a plant and the simulation of its behaviour are evaluated simultaneously.

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

PubMed

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

2011-07-01

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

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

DTIC Science & Technology

1994-09-01

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

Analysis of operating reserve demand curves in power system operations in the presence of variable generation

DOE PAGES

Krad, Ibrahim; Gao, David Wenzhong; Ela, Erik; ...

2017-06-07

The electric power industry landscape is continually evolving. As emerging technologies such as wind and solar generating systems become more cost effective, traditional power system operating strategies will need to be re-evaluated. The presence of wind and solar generation (commonly referred to as variable generation or VG) can increase variability and uncertainty in the net-load profile. One mechanism to mitigate this issue is to schedule and dispatch additional operating reserves. These operating reserves aim to ensure that there is enough capacity online in the system to account for the increased variability and uncertainty occurring at finer temporal resolutions. A newmore » operating reserve strategy, referred to as flexibility reserve, has been introduced in some regions. A similar implementation is explored in this study, and its implications on power system operations are analyzed. Results show that flexibility reserve products can improve economic metrics, particularly in significantly reducing the number of scarcity pricing events, with minimal impacts on reliability metrics and production costs. Furthermore, the production costs increased due to increased VG curtailment - i.e. including the flexible ramping product in the commitment of excess thermal capacity that needed to remain online at the expense of VG output.« less

Analysis of operating reserve demand curves in power system operations in the presence of variable generation

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

Krad, Ibrahim; Gao, David Wenzhong; Ela, Erik

The electric power industry landscape is continually evolving. As emerging technologies such as wind and solar generating systems become more cost effective, traditional power system operating strategies will need to be re-evaluated. The presence of wind and solar generation (commonly referred to as variable generation or VG) can increase variability and uncertainty in the net-load profile. One mechanism to mitigate this issue is to schedule and dispatch additional operating reserves. These operating reserves aim to ensure that there is enough capacity online in the system to account for the increased variability and uncertainty occurring at finer temporal resolutions. A newmore » operating reserve strategy, referred to as flexibility reserve, has been introduced in some regions. A similar implementation is explored in this study, and its implications on power system operations are analyzed. Results show that flexibility reserve products can improve economic metrics, particularly in significantly reducing the number of scarcity pricing events, with minimal impacts on reliability metrics and production costs. Furthermore, the production costs increased due to increased VG curtailment - i.e. including the flexible ramping product in the commitment of excess thermal capacity that needed to remain online at the expense of VG output.« less

Coal Utilization in Schools: Issues and Answers.

ERIC Educational Resources Information Center

Pusey, Robert H.

Coal, at one-third the cost of natural gas and one-fifth the cost of oil, is our cheapest source of energy and is also in abundant supply. Because of significant technological advances, coal-fired equipment now approaches the clean and automatic operational characteristics of gas- and oil-fired boilers. For these reasons, and because schools are…

Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study.

PubMed

McCarthy, Ian M; Hostin, Richard A; Ames, Christopher P; Kim, Han J; Smith, Justin S; Boachie-Adjei, Ohenaba; Schwab, Frank J; Klineberg, Eric O; Shaffrey, Christopher I; Gupta, Munish C; Polly, David W

2014-10-01

Whereas the costs of primary surgery, revisions, and selected complications for adult spinal deformity (ASD) have been individually reported in the literature, the total costs over several years after surgery have not been assessed. The determinants of such costs are also not well understood in the literature. This study analyzes the total hospital costs and operating room (OR) costs of ASD surgery through extended follow-up. Single-center retrospective analysis of consecutive surgical patients. Four hundred eighty-four consecutive patients undergoing surgical treatment for ASD from January 2005 through January 2011 with minimum three levels fused. Costs were collected from hospital administrative data on the total hospital costs incurred for the operation and any related readmissions, expressed in 2010 dollars and discounted at 3.5% per year. Detailed data on OR costs, including implants and biologics, were also collected. We performed a series of paired t tests and Wilcoxon signed-rank tests for differences in total hospital costs over different follow-up periods. The goal of these tests was to identify a time period over which average costs plateau and remain relatively constant over time. Generalized linear model regression was used to estimate the effect of patient and surgical factors on hospital inpatient costs, with different models estimated for different follow-up periods. A similar regression analysis was performed separately for OR costs and all other hospital costs. Patients were predominantly women (n=415 or 86%) with an average age of 48 (18-82) years and an average follow-up of 4.8 (2-8) years. Total hospital costs averaged $120,394, with primary surgery averaging $103,143 and total readmission costs averaging $67,262 per patient with a readmission (n=130 or 27% of all patients). Operating room costs averaged $70,514 per patient, constituting the majority (59%) of total hospital costs. Average total hospital costs across all patients significantly increased (p<.01) after primary surgery, from $111,807 at 1-year follow-up to $126,323 at 4-year follow-up. Regression results also revealed physician preference as the largest determinant of OR costs, accounting for $14,780 of otherwise unexplained OR cost differences across patients, with no significant physician effects on all other non-OR costs (p<.05). The incidence of readmissions increased the average cost of ASD surgery by more than 70%, illustrating the financial burden of revisions/reoperations; however, the cost burden resulting from readmissions appeared to taper off within 5 years after surgery. The estimated impact of physician preference on OR costs also highlights the variation in current practice and the opportunity for large cost reductions via a more standardized approach in the use of implants and biologics. Copyright © 2014 Elsevier Inc. All rights reserved.

Process and economic evaluation of the extraction and purification of recombinant beta-glucuronidase from transgenic corn

PubMed

Evangelista; Kusnadi; Howard; Nikolov

1998-07-01

A process model for the recovery and purification of recombinant beta-glucuronidase (rGUS) from transgenic corn was developed, and the process economics were estimated. The base-case bioprocessing plant operates 7500 h/year processing 1.74 million (MM) kg of transgenic corn containing 0.015% (db) rGUS. The process consists of milling the corn into flour, extraction of protein by using 50 mM sodium phosphate buffer, and rGUS purification by ion exchange and hydrophobic interaction chromatography. About 137 kg of rGUS of 83% (db) purity can be produced annually. The production cost amounted to $43 000/kg of rGUS. The cost of milling, protein extraction, and rGUS purification accounted for 6, 40, and 48% of annual operating cost, respectively. The cost of transgenic corn was 31% of the raw material costs or 6% of the annual operating cost. About 78% of the cost of buffer and water were incurred in the protein extraction section, while 88% of other consumables were from the purification section. The sensitivity analysis indicated that rGUS can be produced profitably from corn even at the 0.015% (db) expression level, assuming a selling price of $100 000/kg GUS. An increase in rGUS expression levels up to 0.08% significantly improves the process economics.

Micro-Grids for Colonias (TX)

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

Dean Schneider; Michael Martin; Renee Berry

2012-07-31

This report describes the results of the final implementation and testing of a hybrid micro-grid system designed for off-grid applications in underserved Colonias along the Texas/Mexico border. The project is a federally funded follow-on to a project funded by the Texas State Energy Conservation Office in 2007 that developed and demonstrated initial prototype hybrid generation systems consisting of a proprietary energy storage technology, high efficiency charging and inverting systems, photovoltaic cells, a wind turbine, and bio-diesel generators. This combination of technologies provided continuous power to dwellings that are not grid connected, with a significant savings in fuel by allowing powermore » generation at highly efficient operating conditions. The objective of this project was to complete development of the prototype systems and to finalize and engineering design; to install and operate the systems in the intended environment, and to evaluate the technical and economic effectiveness of the systems. The objectives of this project were met. This report documents the final design that was achieved and includes the engineering design documents for the system. The system operated as designed, with the system availability limited by maintenance requirements of the diesel gensets. Overall, the system achieved a 96% availability over the operation of the three deployed systems. Capital costs of the systems were dependent upon both the size of the generation system and the scope of the distribution grid, but, in this instance, the systems averaged $0.72/kWh delivered. This cost would decrease significantly as utilization of the system increased. The system with the highest utilization achieved a capitol cost amortized value of $0.34/kWh produced. The average amortized fuel and maintenance cost was $0.48/kWh which was dependent upon the amount of maintenance required by the diesel generator. Economically, the system is difficult to justify as an alternative to grid power. However, the operational costs are reasonable if grid power is unavailable, e.g. in a remote area or in a disaster recovery situation. In fact, avoided fuel costs for the smaller of the systems in use during this project would have a payback of the capital costs of that system in 2.3 years, far short of the effective system life.« less

NASA's Spaceliner Investment Area Technology Activities

NASA Technical Reports Server (NTRS)

Hueter, Uwe; Lyles, Garry M. (Technical Monitor)

2001-01-01

NASA's has established long term goals for access-to-space. The third generation launch systems are to be fully reusable and operational around 2025. The goals for the third generation launch system are to significantly reduce cost and improve safety over current conditions. The Advanced Space Transportation Program Office (ASTP) at the NASA's Marshall Space Flight Center in Huntsville, AL has the agency lead to develop space transportation technologies. Within ASTP, under the Spaceliner Investment Area, third generation technologies are being pursued in the areas of propulsion, airframes, integrated vehicle health management (IVHM), avionics, power, operations, and range. The ASTP program will mature these technologies through both ground and flight system testing. The Spaceliner Investment Area plans to mature vehicle technologies to reduce the implementation risks for future commercially developed reusable launch vehicles (RLV). The plan is to substantially increase the design and operating margins of the third generation RLV (the Space Shuttle is the first generation) by incorporating advanced technologies in propulsion, materials, structures, thermal protection systems, avionics, and power. Advancements in design tools and better characterization of the operational environment will allow improvements in design margins. Improvements in operational efficiencies will be provided through use of advanced integrated health management, operations, and range technologies. The increase in margins will allow components to operate well below their design points resulting in improved component operating life, reliability, and safety which in turn reduces both maintenance and refurbishment costs. These technologies have the potential of enabling horizontal takeoff by reducing the takeoff weight and achieving the goal of airline-like operation. These factors in conjunction with increased flight rates from an expanding market will result in significant improvements in safety and reductions in operational costs of future vehicles. The paper describes current status, future plans and technologies that are being matured by the Spaceliner Investment Area under the Advanced Space Transportation Program Office.

The latest developments and outlook for hydrogen liquefaction technology

NASA Astrophysics Data System (ADS)

Ohlig, K.; Decker, L.

2014-01-01

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

Parts quality management: Direct part marking of data matrix symbol for mission assurance

NASA Astrophysics Data System (ADS)

Moss, Chantrice; Chakrabarti, Suman; Scott, David W.

A United States Government Accountability Office (GAO) review of twelve NASA programs found widespread parts quality problems contributing to significant cost overruns, schedule delays, and reduced system reliability. Direct part marking with Data Matrix symbols could significantly improve the quality of inventory control and parts lifecycle management. This paper examines the feasibility of using direct part marking technologies for use in future NASA programs. A structural analysis is based on marked material type, operational environment (e.g., ground, suborbital, Low Earth Orbit), durability of marks, ease of operation, reliability, and affordability. A cost-benefits analysis considers marking technology (label printing, data plates, and direct part marking) and marking types (two-dimensional machine-readable, human-readable). Previous NASA parts marking efforts and historical cost data are accounted for, including in-house vs. outsourced marking. Some marking methods are still under development. While this paper focuses on NASA programs, results may be applicable to a variety of industrial environments.

Clean then Assemble Versus Assemble then Clean: Several Comparisons

NASA Technical Reports Server (NTRS)

Welker, Roger W.

2004-01-01

Cleanliness of manufactured parts and assemblies is a significant issue in many industries including disk drives, semiconductors, aerospace, and medical devices. Clean manufacturing requires cleanroom floor space and cleaning technology that are both expensive to own and expensive to operate. Strategies to reduce these costs are an important consideration. One strategy shown to be effective at reducing costs is to assemble parts into subassemblies and then clean the subassembly, rather than clean the individual parts first and then assemble them. One advantage is that assembly outside of the cleanroom reduces the amount of cleanroom floor space and its associated operating cost premium. A second advantage is that this strategy reduces the number of individual parts that must be cleaned prior to assembly, reducing the number of cleaning baskets, handling and, possibly, reducing the number of cleaners. The assemble then clean strategy also results in a part that is significantly cleaner because contamination generated during the assembly steps are more effectively removed that normally can be achieved by hand wiping after assembly in the cleanroom.

Parts Quality Management: Direct Part Marking of Data Matrix Symbol for Mission Assurance

NASA Technical Reports Server (NTRS)

Moss, Chantrice; Chakrabarti, Suman; Scott, David W.

2013-01-01

A United States Government Accountability Office (GAO) review of twelve NASA programs found widespread parts quality problems contributing to significant cost overruns, schedule delays, and reduced system reliability. Direct part marking with Data Matrix symbols could significantly improve the quality of inventory control and parts lifecycle management. This paper examines the feasibility of using direct part marking technologies for use in future NASA programs. A structural analysis is based on marked material type, operational environment (e.g., ground, suborbital, Low Earth Orbit), durability of marks, ease of operation, reliability, and affordability. A cost-benefits analysis considers marking technology (label printing, data plates, and direct part marking) and marking types (two-dimensional machine-readable, human-readable). Previous NASA parts marking efforts and historical cost data are accounted for, including inhouse vs. outsourced marking. Some marking methods are still under development. While this paper focuses on NASA programs, results may be applicable to a variety of industrial environments.

Conceptual design study of advanced acoustic-composite nacelles

NASA Technical Reports Server (NTRS)

Nordstrom, K. E.; Marsh, A. H.; Sargisson, D. F.

1975-01-01

Conceptual studies were conducted to assess the impact of incorporating advanced technologies in the nacelles of a current wide-bodied transport and an advanced technology transport. The improvement possible in the areas of fuel consumption, flyover noise levels, airplane weight, manufacturing costs, and airplane operating cost were evaluated for short and long-duct nacelles. Use of composite structures for acoustic duct linings in the fan inlet and exhaust ducts was considered as well as for other nacelle components. For the wide-bodied transport, the use of a long-duct nacelle with an internal mixer nozzle in the primary exhaust showed significant improvement in installed specific fuel consumption and airplane direct operating costs compared to the current short-duct nacelle. The long-duct mixed-flow nacelle is expected to achieve significant reductions in jet noise during takeoff and in turbo-machinery noise during landing approach. Recommendations were made of the technology development needed to achieve the potential fuel conservation and noise reduction benefits.

Operations analysis (study 2.1). Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1975-01-01

Subjects related to future STS operations concepts were investigated. The majority of effort was directed at assessing the benefits of automated space servicing concepts as related to improvements in payload procurement and shuttle utilization. Another subject was directed at understanding shuttle upper stage software development and recurring costs relative to total program projections. Space serving of automated payloads is addressed by examining the broad spectrum of payload applications with the belief that shared logistic operations will be a major contributor to reduction of future program costs. However, there are certain requirements for support of payload operations, such as availability of the payload, that may place demands upon the shuttle fleet. Because future projections of the NASA Mission Model are only representative of the payload traffic, it is important to recognize that it is the general character of operations that is significant rather than service to any single payload program.

Risk-Assessment Score and Patient Optimization as Cost Predictors for Ventral Hernia Repair.

PubMed

Saleh, Sherif; Plymale, Margaret A; Davenport, Daniel L; Roth, John Scott

2018-04-01

Ventral hernia repair (VHR) is associated with complications that significantly increase healthcare costs. This study explores the associations between hospital costs for VHR and surgical complication risk-assessment scores, need for cardiac or pulmonary evaluation, and smoking or obesity counseling. An IRB-approved retrospective study of patients having undergone open VHR over 3 years was performed. Ventral Hernia Risk Score (VHRS) for surgical site occurrence and surgical site infection, and the Ventral Hernia Working Group grade were calculated for each case. Also recorded were preoperative cardiology or pulmonary evaluations, smoking cessation and weight reduction counseling, and patient goal achievement. Hospital costs were obtained from the cost accounting system for the VHR hospitalization stratified by major clinical cost drivers. Univariate regression analyses were used to compare the predictive power of the risk scores. Multivariable analysis was performed to develop a cost prediction model. The mean cost of index VHR hospitalization was $20,700. Total and operating room costs correlated with increasing CDC wound class, VHRS surgical site infection score, VHRS surgical site occurrence score, American Society of Anesthesiologists class, and Ventral Hernia Working Group (all p < 0.01). The VHRS surgical site infection scores correlated negatively with contribution margin (-280; p < 0.01). Multivariable predictors of total hospital costs for the index hospitalization included wound class, hernia defect size, age, American Society of Anesthesiologists class 3 or 4, use of biologic mesh, and 2+ mesh pieces; explaining 73% of the variance in costs (p < 0.001). Weight optimization significantly reduced direct and operating room costs (p < 0.05). Cardiac evaluation was associated with increased costs. Ventral hernia repair hospital costs are more accurately predicted by CDC wound class than VHR risk scores. A straightforward 6-factor model predicted most cost variation for VHR. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A contemporary cost analysis of postoperative morbidity after coronary artery bypass grafting with and without concomitant aortic valve replacement to improve patient quality and cost-effective care.

PubMed

LaPar, Damien J; Crosby, Ivan K; Rich, Jeffrey B; Fonner, Edwin; Kron, Irving L; Ailawadi, Gorav; Speir, Alan M

2013-11-01

The financial burden of postoperative morbidity after cardiac operations remains ill defined. This study evaluated the costs associated with the performance of coronary artery bypass grafting (CABG) with and without aortic valve replacement (AVR) and determined the incremental costs associated with major postoperative complications. A total of 65,534 regional patients undergoing CABG (n = 55,167) ± AVR (n = 10,367) were evaluated from 2001 to 2011. Patient-related, hospital-related, and procedure-related cost data were analyzed by use of Medicare-based cost reports. Hierarchical multivariable regression modeling was used to estimate risk-adjusted incremental cost differences in postoperative complications. The mean age was 64 years, and women accounted for 31% of patients. CABG + AVR patients had higher rates of overall complication (40% vs 35%, p < 0.001) and operative mortality (5% vs 3%, p < 0.001) than did CABG patients. CABG + AVR patients also accrued increased median postoperative lengths of stay (7 vs 5 days, p < 0.001) and total costs ($26,527 vs $24,475, p < 0.001). After mortality risk adjustment, significant positive relationships existed between total costs and major postoperative complications. Interestingly, the highest incremental costs among CABG patients included newly instituted hemodialysis ($71,833), deep sternal wound infection ($56,003), and pneumonia ($50,025). Among CABG + AVR patients, these complications along with perioperative myocardial infarction ($68,917) dominated costs. Postoperative complications after CABG ± AVR are associated with significantly increased incremental costs. The most costly complications include newly instituted hemodialysis, infectious complications, and perioperative myocardial infarction. Identification of the most common and the most costly complications provides opportunities to target improvement in patient quality and the delivery of cost-effective care. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Minimum nurse staffing legislation and the financial performance of California hospitals.

PubMed

Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

2012-06-01

To estimate the effect of minimum nurse staffing ratios on California acute care hospitals' financial performance. Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1=lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. © Health Research and Educational Trust.

A Communications-based Mission Planning Tool Concept for Low-cost Tactical UXV Operations

DTIC Science & Technology

2014-04-01

communication with its base station. Significance to defence and security The Royal Canadian Navy ( RCN ) makes extensive use of unmanned aerial...further concepts for their use in RCN operations, such as off-board jamming. Communication with UAVs or USVs (UXVs) will be lost if the UXV travels too...conditions that allow communications to be extended to areas beyond the expected operating range of the UXV. This should benefit RCN operations and would

Intelligent electric vehicle charging: Rethinking the valley-fill

NASA Astrophysics Data System (ADS)

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

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

Analyzing the cost of screening selectee and non-selectee baggage.

PubMed

Virta, Julie L; Jacobson, Sheldon H; Kobza, John E

2003-10-01

Determining how to effectively operate security devices is as important to overall system performance as developing more sensitive security devices. In light of recent federal mandates for 100% screening of all checked baggage, this research studies the trade-offs between screening only selectee checked baggage and screening both selectee and non-selectee checked baggage for a single baggage screening security device deployed at an airport. This trade-off is represented using a cost model that incorporates the cost of the baggage screening security device, the volume of checked baggage processed through the device, and the outcomes that occur when the device is used. The cost model captures the cost of deploying, maintaining, and operating a single baggage screening security device over a one-year period. The study concludes that as excess baggage screening capacity is used to screen non-selectee checked bags, the expected annual cost increases, the expected annual cost per checked bag screened decreases, and the expected annual cost per expected number of threats detected in the checked bags screened increases. These results indicate that the marginal increase in security per dollar spent is significantly lower when non-selectee checked bags are screened than when only selectee checked bags are screened.

Development of the Architectural Simulation Model for Future Launch Systems and its Application to an Existing Launch Fleet

NASA Technical Reports Server (NTRS)

Rabadi, Ghaith

2005-01-01

A significant portion of lifecycle costs for launch vehicles are generated during the operations phase. Research indicates that operations costs can account for a large percentage of the total life-cycle costs of reusable space transportation systems. These costs are largely determined by decisions made early during conceptual design. Therefore, operational considerations are an important part of vehicle design and concept analysis process that needs to be modeled and studied early in the design phase. However, this is a difficult and challenging task due to uncertainties of operations definitions, the dynamic and combinatorial nature of the processes, and lack of analytical models and the scarcity of historical data during the conceptual design phase. Ultimately, NASA would like to know the best mix of launch vehicle concepts that would meet the missions launch dates at the minimum cost. To answer this question, we first need to develop a model to estimate the total cost, including the operational cost, to accomplish this set of missions. In this project, we have developed and implemented a discrete-event simulation model using ARENA (a simulation modeling environment) to determine this cost assessment. Discrete-event simulation is widely used in modeling complex systems, including transportation systems, due to its flexibility, and ability to capture the dynamics of the system. The simulation model accepts manifest inputs including the set of missions that need to be accomplished over a period of time, the clients (e.g., NASA or DoD) who wish to transport the payload to space, the payload weights, and their destinations (e.g., International Space Station, LEO, or GEO). A user of the simulation model can define an architecture of reusable or expendable launch vehicles to achieve these missions. Launch vehicles may belong to different families where each family may have it own set of resources, processing times, and cost factors. The goal is to capture the required resource levels of the major launch elements and their required facilities. The model s output can show whether or not a certain architecture of vehicles can meet the launch dates, and if not, how much the delay cost would be. It will also produce aggregate figures of missions cost based on element procurement cost, processing cost, cargo integration cost, delay cost, and mission support cost. One of the most useful features of this model is that it is stochastic where it accepts statistical distributions to represent the processing times mimicking the stochastic nature of real systems.

Developments in abatement technology for MOCVD processing

NASA Astrophysics Data System (ADS)

Sweeney, Joseph; Marganski, Paul; Olander, Karl; Watanabe, Tadaharu; Tomita, Nobuyasu; Orlando, Gary; Torres, Robert

2004-12-01

A newly developed technical solution has been developed for hydride gas abatement that utilizes a new material. The ULTIMA-Sorb™ material provides high capacity but low heat of reaction with the hydride gases. The new technology results in a low cost of ownership (COO) with stable operation and also reduces the cost and quantity of waste disposal. This can be significant benefit for device manufacturers since it provides a viable and cost effective solution without any risk of arsenic leakage that is a primary concern with wet chemical scrubber systems. The contents of this paper will discuss the technical and economic benefits of the newly developed material in comparison to conventional abatement materials and systems. The capacity of the dry abatement materials significantly influences both COO relating to cash outflow and the cost of lost production. High capacity materials enable significant savings in cost of lost production in cases of low and high factory utilization conditions. Capacity of the abatement material appears to be the largest single factor to reduce COO of dry abatement systems.

Association Between Surgeon Scorecard Use and Operating Room Costs.

PubMed

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

2017-03-01

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

Water Utility.

ERIC Educational Resources Information Center

Steinbach, Paul

2002-01-01

Describes how sharing campus aquatic facilities can help colleges cover the significant costs of operation. Discusses the priority-setting and planning required to constantly circulate different user groups in and out of pools. (EV)

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

NASA Astrophysics Data System (ADS)

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

2016-08-01

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

Distributed Generation Energy Technology Operations and Maintenance Costs |

Science.gov Websites

Costs Distributed Generation Energy Technology Operations and Maintenance Costs Transparent Cost Database Button The following charts indicate recent operations and maintenance (O&M) cost estimates available national-level cost data from a variety of sources. Costs in your specific location will vary. The

Use of a multimission system for cost effective support of planetary science data processing

NASA Technical Reports Server (NTRS)

Green, William B.

1994-01-01

JPL's Multimission Operations Systems Office (MOSO) provides a multimission facility at JPL for processing science instrument data from NASA's planetary missions. This facility, the Multimission Image Processing System (MIPS), is developed and maintained by MOSO to meet requirements that span the NASA family of planetary missions. Although the word 'image' appears in the title, MIPS is used to process instrument data from a variety of science instruments. This paper describes the design of a new system architecture now being implemented within the MIPS to support future planetary mission activities at significantly reduced operations and maintenance cost.

Final Report - High Performance, Durable, Low Cost Membrane Electrode Assemblies for Transportation Applications

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

Steinbach, Andrew

2017-05-31

The primary project objective was development of improved polymer electrolyte membrane fuel cell (PEMFC) membrane electrode assemblies (MEAs) which address the key DOE barriers of performance, durability and cost. Additional project objectives were to address commercialization barriers specific to MEAs comprising 3M nanostructured thin film (NSTF) electrodes, including a larger-than-acceptable sensitivity to operating conditions, an unexplained loss of rated power capability with operating time, and slow break-in conditioning. Significant progress was made against each of these barriers, and most DOE 2020 targets were met or substantially approached.

Pre-operative labs: Wasted dollars or predictors of post-operative cardiac and septic events in orthopaedic trauma patients?

PubMed

Lakomkin, Nikita; Sathiyakumar, Vasanth; Dodd, Ashley C; Jahangir, A Alex; Whiting, Paul S; Obremskey, William T; Sethi, Manish K

2016-06-01

As US healthcare expenditures continue to rise, there is significant pressure to reduce the cost of inpatient medical services. Studies have estimated that over 70% of routine labs may not yield clinical benefits while adding over $300 in costs per day for every inpatient. Although orthopaedic trauma patients tend to have longer inpatient stays and hip fractures have been associated with significant morbidity, there is a dearth of data examining pre-operative labs in predicting post-operative adverse events in these populations. The purpose of this study was to assess whether pre-operative labs significantly predict post-operative cardiac and septic complications in orthopaedic trauma and hip fracture patients. Between 2006 and 2013, 56,336 (15.6%) orthopaedic trauma patients were identified and 27,441 patients (7.6%) were diagnosed with hip fractures. Pre-operative labs included sodium, BUN, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white count, hematocrit, platelet count, prothrombin time, INR, and partial thromboplastin time. For each of these labs, patients were deemed to have normal or abnormal values. Patients were noted to have developed cardiac or septic complications if they sustained (1) myocardial infarction (MI), (2) cardiac arrest, or (3) septic shock within 30 days after surgery. Separate regressions incorporating over 40 patient characteristics including age, gender, pre-operative comorbidities, and labs were performed for orthopaedic trauma patients in order to determine whether pre-operative labs predicted adverse cardiac or septic outcomes. 749 (1.3%) orthopaedic trauma patients developed cardiac complications and 311 (0.6%) developed septic shock. Multivariate regression demonstrated that abnormal pre-operative platelet values were significantly predictive of post-operative cardiac arrest (OR: 11.107, p=0.036), and abnormal bilirubin levels were predictive (OR: 8.487, p=0.008) of the development of septic shock in trauma patients. In the hip fracture cohort, abnormal partial thromboplastin time was significantly associated with post-operative myocardial infarction (OR: 15.083, p=0.046), and abnormal bilirubin (OR: 58.674, p=0.002) significantly predicted the onset of septic shock. This is the first study to demonstrate the utility of pre-operative labs in predicting perioperative cardiac and septic adverse events in orthopaedic trauma and hip fracture patients. Particular attention should be paid to haematologic/coagulation labs (platelets, PTT) and bilirubin values. Prognostic Level II. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

NASA Technical Reports Server (NTRS)

Oh, David Y.; Goebel, Dan M.

2006-01-01

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

Hospital costs associated with adverse events in gynecological oncology.

PubMed

Kondalsamy-Chennakesavan, Srinivas; Gordon, Louisa G; Sanday, Karen; Bouman, Chantal; De Jong, Suzanne; Nicklin, James; Land, Russell; Obermair, Andreas

2011-04-01

Treatment for gynecological malignancies is complex and may cause unintended or accidental adverse events (AE). We evaluated the costs of hospitalization associated with those AEs among patients who had an abdominal or laparoscopic procedure for proven or suspected gynecological cancer at a tertiary gynecological cancer center in Australia. Data on AEs were prospectively collected and matched with cost data (AU$ 2008) from the hospital's clinical costing unit and linked to demographical, clinical and histopathological data. Total costs were adjusted for various clinical factors and estimated using log-transformed ordinary least squared regression. Back-transformation was achieved using smearing factors. From epidemiological data, we also estimated the costs of AEs Australia-wide and undertook scenario and probabilistic sensitivity analyses to investigate the potential cost impact of reducing AEs. A total of 369 patients had surgical procedures of which 95 patients (26%) had at least one AE. Patients with AEs incurred an extra AU$12,780 on average, adjusted for age, co-morbidities, ovarian cancer, major or minor complications, surgical complexity, presence of malignancy and abdominal surgery. Mean adjusted costs (95% CI) for patients with intra-operative, minor post-operative and major post-operative AEs were AU$40,746 (11,582-71,859) AU$18,459 (17,270-19,713) and AU$67,656 (5324-131,761), respectively. Up to an estimated AU$20.6 million/year could be saved if the AEs were reduced by 40%. Adverse events are associated with significantly increased hospitalization costs and appropriate evidence-based interventions are justified to minimize AEs. Copyright © 2010 Elsevier Inc. All rights reserved.

Space station operations management

NASA Technical Reports Server (NTRS)

Cannon, Kathleen V.

1989-01-01

Space Station Freedom operations management concepts must be responsive to the unique challenges presented by the permanently manned international laboratory. Space Station Freedom will be assembled over a three year period where the operational environment will change as significant capability plateaus are reached. First Element Launch, Man-Tended Capability, and Permanent Manned Capability, represent milestones in operational capability that is increasing toward mature operations capability. Operations management concepts are being developed to accomodate the varying operational capabilities during assembly, as well as the mature operational environment. This paper describes operations management concepts designed to accomodate the uniqueness of Space Station Freedoom, utilizing tools and processes that seek to control operations costs.

Surgeon and hospital cost variability for septoplasty and inferior turbinate reduction.

PubMed

Thomas, Andrew; Alt, Jeremiah; Gale, Craig; Vijayakumar, Sathya; Padia, Reema; Peters, Matthew; Champagne, Trevor; Meier, Jeremy D

2016-10-01

Septoplasty and turbinate reduction (STR) is a common procedure for which cost reduction efforts may improve value. The purpose of this study was to identify sources of variation in medical facility and surgeon costs associated with STR, and whether these costs correlated with short-term complications. An observational cohort study was performed in a multifacility network using a standardized cost-accounting system to determine costs associated with adult STR from January 1, 2008 to July 31, 2015. A total of 4007 cases, performed at 21 facilities, by 72 different surgeons were included in the study. Total costs, variable costs, operating room (OR) time, and 30-day complications (eg, epistaxis) were compared among surgeons, facilities, and specialties. Total procedure cost: (mean ± standard deviation [SD]) $2503 ± $790 (range, $852 to $10,559). Mean total variable cost: $1147 ± $423 (range, $400 to $5,081). Intersurgeon and interfacility variability was significant for total cost (p < 0.0001) and OR time (p < 0.0001). Intersurgeon OR supply cost variability was also significant (p < 0.0001). Otolaryngologists had less total cost (p < 0.0001), OR time/cost (p < 0.0001), and complications (p = 0.0164), but greater supply cost (p < 0.0001), than other specialties. There is wide variation in cost associated with STR. Significant variance in OR time and supply cost between surgeons suggests these are potential areas for cost reduction. Although no increased 30-day complications were seen with faster and less costly surgeries, further research is needed to evaluate how time and cost relate to quality of care. © 2016 ARS-AAOA, LLC.

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

PubMed Central

2014-01-01

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

A productivity and cost comparison of two systems for producing biomass fuel from roadside forest treatment residues

Treesearch

Nathaniel Anderson; Woodam Chung; Dan Loeffler; John Greg Jones

2012-01-01

Forest operations generate large quantities of forest biomass residues that can be used for production of bioenergy and bioproducts. However, a significant portion of recoverable residues are inaccessible to large chip vans, making use financially infeasible. New production systems must be developed to increase productivity and reduce costs to facilitate use of these...

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

Zayas, Jose; Derby, Mike; Ralston, Kiersten

Atmosphere to Electrons (A2e) is a multi-year U.S. Department of Energy (DOE) research initiative targeting significant reductions in the cost of wind energy through an improved understanding of the complex physics governing electricity generation by wind plants. The goal of A2e is to ensure future wind plants are sited, built, and operated in a way that produces the most cost-effective, usable electric power.

One hospital, one appendectomy: The cost effectiveness of a standardized doctor's preference card.

PubMed

Skarda, David E; Rollins, Michael; Andrews, Seth; McFadden, Molly; Barnhart, Doug; Meyers, Rebecka; Scaife, Eric

2015-06-01

Appendicitis in children provides a unique opportunity to explore changes that reduce variation, reduce cost, and improve value. In this study we sought to evaluate the effectiveness of standardization of surgical technique and intraoperative disposable device utilization for laparoscopic appendectomy among all surgeons at a tertiary children's hospital. All 6 surgeons at our tertiary children's hospital agreed to standardize to a single technique of performing a laparoscopic appendectomy. We collected data on all pediatric patients who had a laparoscopic appendectomy following implementation of the uniform doctor's preference card (DPC) (March 1, 2013 to February 28, 2014) and compared them to a historical control group. Implementation of the uniform DPC decreased the device cost per appendectomy from $844.11 to $305.32. Operative times (skin incision to skin closure) were 34.8 minutes prior to the uniform DPC and 37.0 minutes using the uniform DPC. There were no significant differences in postappendectomy outcomes. We have demonstrated that implementation of a uniform DPC and technical standardization for laparoscopic appendectomy can significantly reduce cost. Furthermore, this can occur without dramatically increasing operative times, length of stay, or postoperative complications. Copyright © 2015 Elsevier Inc. All rights reserved.

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.

Applying activity-based costing to the nuclear medicine unit.

PubMed

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

2005-08-01

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

C5 palsy after posterior cervical decompression and fusion: cost and quality-of-life implications.

PubMed

Miller, Jacob A; Lubelski, Daniel; Alvin, Matthew D; Benzel, Edward C; Mroz, Thomas E

2014-12-01

C5 palsy is a debilitating postoperative complication of cervical decompression surgery. Although the prognosis is typically good, patients may be unable to perform basic activities of daily living, resulting in a decreased quality of life. No studies have investigated the quality-of-life and financial implications. The aim of the study was to determine the impact on quality-of-life and costs of C5 palsy after posterior cervical decompression and fusion (PCDF). A 2:1 matched retrospective cohort study was conducted at a single tertiary-care institution between 2007 and 2012. Individuals who had undergone PCDF were included. Self-reported: Euroqol-5 Dimensions quality-of-life survey. Physiologic: postoperative change in deltoid and biceps strength via manual muscle testing. Functional: cost of interventions and missed workdays postoperatively. Individuals with postoperative C5 palsy were matched to controls based on age, gender, body mass index, and diagnosis. Demographic, operative, postoperative, quality-of-life, and cost data were collected for both the C5 palsy and control groups, with 1-year follow-up. We reviewed 245 patients who underwent PCDF and 17 were identified (6.9%) with C5 palsy and matched to 34 controls. No significant differences in demographic or operative characteristics were observed between groups. The C5 palsy group had a significantly reduced capacity for self-care in the immediate postoperative (2.0±0.71 vs. 1.2±0.4, p<.001) and long-term (1.6±0.6 vs. 1.2±0.4, p=.004) periods and a significantly reduced capacity for completion of usual activities (2.4±0.7 vs. 1.9±0.6, p=.014) compared with controls. Furthermore, the C5 group had a significantly greater cost of physical/occupational therapy, an increase of $2,078 ($4,386±$2,801 vs. $2,307±$1,907, p=.013). There were no significant differences between groups in the cost of hospital stay, surgery, or other direct or indirect costs. Overall, there was a significantly greater cost ($1,918) for the C5 palsy group compared with the control group ($7,584±$3,992 vs. $5,666±$2,359, respectively, p=.038). This study represents the first quantification of the impact of C5 palsy on patients' quality of life and the associated costs for care. We found that C5 palsy adds a significant burden on patients' quality of life and presents a financial burden to the health-care system. Copyright © 2014 Elsevier Inc. All rights reserved.

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.

24 CFR 583.125 - Grants for operating costs.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Operating costs are those associated with the day-to-day operation of the supportive housing. They also... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Grants for operating costs. 583.125... for operating costs. (a) General. HUD will provide grants to pay a portion (as described in § 583.130...

Energy cost reduction in retailing

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

Not Available

The handbook was developed to help retail store owners cut the cost of energy in their businesses. It shows how to recognize and act on energy waste in interior and outdoor lighting, space heating, air conditioning and ventilation, general maintenance, warehousing, delivery, and refrigeration. Energy use in retail stores is significant because of the importance of environmental control, the role of lighting in merchandising, and long hours of operation. A 20 to 30% net cost reduction is possible by applying the recommendations in this handbook.

Economics of MRI Operations After Implementation of Interpersonal Skills Training.

PubMed

Ladapo, Joseph A; Spritzer, Charles E; Nguyen, Xuan V; Pool, Judy; Lang, Elvira

2018-03-09

Examine the cost of MRI operations before and after implementation of interpersonal skills training to reduce unanticipated patient-related events in an academic medical center. Teams at four MRI sites (two hospital-based, two freestanding) were trained in evidence-based communication skills in February to April 2015. Training was designed to enable staff members to help patients mobilize their innate coping skills in response to any distress they experienced during their MRI visit. Data were collected before training and afterward from January to June 2016. Staff reported the incidence of disruptive motion, sedation use, MRI delays, incomplete examinations, and no-shows. Cost and revenue associated with MRI operations and staff and physician costs were estimated using Medicare and private insurance rates and data from the US Bureau of Labor Statistics. The study included 12,930 outpatient MRI visits. From baseline to follow-up, average monthly patient volume increased from 1,105 to 1,463 at hospital MRI sites and from 245 to 313 at freestanding MRI sites. Patient factors necessitating sedation or interfering with image progression or quality decreased from 9.0% to 5.5% at hospital sites and from 3.1% to 1.2% at freestanding sites. These changes translated into a reduction in operational costs of $4,600 per 1,000 scheduled patients and an increase in profit of $8,370 per 1,000 scheduled patients in hospital MRI sites, and a corresponding increase in operational costs of $1,570 per 1,000 scheduled-patients and an increase in profit of $12,800 per 1,000 scheduled patients in freestanding MRI sites. We found significant improvements in MRI operational efficiency after interpersonal skills team training, which were associated with reductions in costs and growth in revenue. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Lindstrom, Erik Vilhelm Mathias

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

Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial.

PubMed

Sippola, S; Grönroos, J; Tuominen, R; Paajanen, H; Rautio, T; Nordström, P; Aarnio, M; Rantanen, T; Hurme, S; Salminen, P

2017-09-01

An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial. The APPAC multicentre, non-inferiority RCT was conducted on patients with CT-confirmed uncomplicated acute appendicitis. Patients were assigned randomly to appendicectomy or antibiotic treatment. All costs were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis during the 1-year follow-up. The cost estimates were based on cost levels for the year 2012. Some 273 patients were assigned to the appendicectomy group and 257 to antibiotic treatment. Most patients randomized to antibiotic treatment did not require appendicectomy during the 1-year follow-up. In the operative group, overall societal costs (€5989·2, 95 per cent c.i. 5787·3 to 6191·1) were 1·6 times higher (€2244·8, 1940·5 to 2549·1) than those in the antibiotic group (€3744·4, 3514·6 to 3974·2). In both groups, productivity losses represented a slightly higher proportion of overall societal costs than all treatment costs together, with diagnostics and medicines having a minor role. Those in the operative group were prescribed significantly more sick leave than those in the antibiotic group (mean(s.d.) 17·0(8·3) (95 per cent c.i. 16·0 to 18·0) versus 9·2(6·9) (8·3 to 10·0) days respectively; P < 0·001). When the age and sex of the patient as well as the hospital were controlled for simultaneously, the operative treatment generated significantly more costs in all models. Patients receiving antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

Analysis of actual healthcare costs of early versus interval cholecystectomy in acute cholecystitis.

PubMed

Tan, Cheryl H M; Pang, Tony C Y; Woon, Winston W L; Low, Jee Keem; Junnarkar, Sameer P

2015-03-01

Healthcare cost modeling have favored early (ELC) over interval laparoscopic cholecystectomy (ILC) for acute cholecystitis (AC). However, actual costs of treatment have never been studied. The aim of the present study was to compare actual hospital costs involved in ELC and ILC in patients with AC. Retrospective study of patients who underwent laparoscopic cholecystectomy for AC was conducted. Demographic, clinical, operative data and costs were extracted and analyzed. Between 2011 and 2013, 201 had laparoscopic surgery for AC at Tan Tock Seng Hospital, Singapore. One hundred and thirty-four (67%) patients underwent ELC (≤7 days of presentation, within index admission). Median total length of stay (LOS) was 4.6 and 6.8 days for ELC and ILC groups, respectively (P = 0.006). Patients who had ELC also had significantly lesser total number of admissions (P < 0.001). The median (IQR) total inpatient costs were €4.4 × 10(3) (3.6-5.6) and €5.5 × 10(3) (4.0-7.5) for ELC and ILC patients, respectively (P < 0.007). Costs associated with investigations were significantly higher in the ILC group (P = 0.039), of which serological costs made most difference (P < 0.005). The ward costs were also significantly higher in the ILC group. The cost differences reflect the significantly increased total LOS, and repeat presentations associated with ILC. Therefore, ELC should be the preferred management strategy for AC. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

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

PubMed

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

2012-01-01

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

40 CFR 300.435 - Remedial design/remedial action, operation and maintenance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... differences when the differences in the remedial or enforcement action, settlement, or consent decree..., performance, or cost. To issue an explanation of significant differences, the lead agency shall: (A) Make the explanation of significant differences and supporting information available to the public in the...

40 CFR 300.435 - Remedial design/remedial action, operation and maintenance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... differences when the differences in the remedial or enforcement action, settlement, or consent decree..., performance, or cost. To issue an explanation of significant differences, the lead agency shall: (A) Make the explanation of significant differences and supporting information available to the public in the...

40 CFR 300.435 - Remedial design/remedial action, operation and maintenance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... differences when the differences in the remedial or enforcement action, settlement, or consent decree..., performance, or cost. To issue an explanation of significant differences, the lead agency shall: (A) Make the explanation of significant differences and supporting information available to the public in the...

40 CFR 300.435 - Remedial design/remedial action, operation and maintenance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... differences when the differences in the remedial or enforcement action, settlement, or consent decree..., performance, or cost. To issue an explanation of significant differences, the lead agency shall: (A) Make the explanation of significant differences and supporting information available to the public in the...

40 CFR 300.435 - Remedial design/remedial action, operation and maintenance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... differences when the differences in the remedial or enforcement action, settlement, or consent decree..., performance, or cost. To issue an explanation of significant differences, the lead agency shall: (A) Make the explanation of significant differences and supporting information available to the public in the...

Association between patient-centered medical home rating and operating cost at federally funded health centers.

PubMed

Nocon, Robert S; Sharma, Ravi; Birnberg, Jonathan M; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H

2012-07-04

Little is known about the cost associated with a health center's rating as a patient-centered medical home (PCMH). To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD, 12; range, 21-90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86-$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27,300; 95% CI, $3047-$57,804) and higher operating cost per patient per month ($1.06; 95% CI, $0.29-$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32,731; 95% CI, $1571-$73,670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54-$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39,809; 95% CI, $1893-$63,169). According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost.

Effects of a cost-effective surgical workflow on cosmesis and patient's satisfaction in open thyroid surgery.

PubMed

Billmann, Franck; Bokor-Billmann, Therezia; Voigt, Joachim; Kiffner, Erhard

2013-01-01

In thyroid surgery, minimally invasive procedures are thought to improve cosmesis and patient's satisfaction. However, studies using standardized tools are scarce, and results are controversial. Moreover, minimally invasive techniques raise the question of material costs in a context of health spending cuts. The aim of the present study is to test a cost-effective surgical workflow to improve cosmesis in conventional open thyroid surgery. Our study ran between January 2009 and November 2010, and was based on a prospectively maintained thyroid surgery register. Patients operated for benign thyroid diseases were included. Since January 2010, a standardized surgical workflow was used in addition to the reference open procedure to improve the outcome. Two groups were created: (1) G1 group (patients operated with the reference technique), (2) G2 group (patients operated with our workflow in addition to reference technique). Patients were investigated for postoperative outcomes, self-evaluated body image, cosmetic and self-confidence scores. 820 patients were included in the present study. The overall body image and cosmetic scores were significantly better in the G2 group (P < 0.05). No significant difference was noted in terms of surgical outcomes, scar length, and self-confidence. Our surgical workflow in conjunction with the reference technique is safe and shows significant better results in terms of body image and cosmesis than do the reference technique alone. Thus, we recommend its implementation in order to improve outcomes in a cost-effective way. The limitations of the present study should be kept in mind in the elaboration of future studies. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

High-Speed, High-Temperature Finger Seal Test Results

NASA Technical Reports Server (NTRS)

Proctor, Margaret P.; Kumar, Arun; Delgado, Irebert R.

2002-01-01

Finger seals have significantly lower leakage rates than conventional labyrinth seals used in gas turbine engines and are expected to decrease specific fuel consumption by over 1 percent and to decrease direct operating cost by over 0.5 percent. Their compliant design accommodates shaft growth and motion due to thermal and dynamic loads with minimal wear. The cost to fabricate these finger seals is estimated to be about half the cost to fabricate brush seals. A finger seal has been tested in NASA's High Temperature, High Speed Turbine Seal Test Rig at operating conditions up to 1200 F, 1200 ft/s, and 75 psid. Static, performance and endurance test results are presented. While seal leakage and wear performance are acceptable, further design improvements are needed to reduce the seal power loss.

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

NASA Technical Reports Server (NTRS)

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

1977-01-01

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

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

PubMed

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

2011-01-01

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

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

PubMed Central

2011-01-01

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

Integrated operations/payloads/fleet analysis. Volume 3: System costs. Appendix A: Program direct costs

NASA Technical Reports Server (NTRS)

1971-01-01

Individualized program direct costs for each satellite program are presented. This breakdown provides the activity level dependent costs for each satellite program. The activity level dependent costs, or, more simply, program direct costs, are comprised of the total payload costs (as these costs are strictly program dependent) and the direct launch vehicle costs. Only those incremental launch vehicle costs associated directly with the satellite program are considered. For expendable launch vehicles the direct costs include the vehicle investment hardware costs and the launch operations costs. For the reusable STS vehicles the direct costs include only the launch operations, recovery operations, command and control, vehicle maintenance, and propellant support. The costs associated with amortization of reusable vehicle investment, RDT&E range support, etc., are not included.

SeaRover: An Emerging Technology for Sea Surface Sensor Networks

NASA Astrophysics Data System (ADS)

Fong, T.; Kudela, R.; Curcio, J.; Davidson, K.; Darling, D.; Kirkwood, B.

2005-12-01

Introduction - SeaRover is envisioned as an autonomous surface vehicle (ASV) for coastal operations. It is intended to lower the cost of existing marine survey applications while enabling new science missions. The current conceptual design is a small vehicle with hull and propulsion system optimized to eliminate cavitation and EM noise. SeaRover will make significant advances over existing platforms by providing longer duration science missions, better positioning and mission control, larger power budgets for instrumentation and significantly lower operational costs than existing vehicles. Science Enabled by SeaRover - SeaRover's unique design and autonomous capability provides several advantages compared to traditional autonomous underwater vehicles (AUV's) and crewed surface vessels: (1) Near surface sampling: SeaRover can sample within the top 1-2 meters. This is difficult to do with crewed vessels because of draft and perturbations from the hull. (2) Adaptive monitoring of dynamic events: SeaRover will be capable of intelligent decision making, as well as real-time remote control. This will enable highly-responsive autonomous tracking of moving phenomena (e.g., algal bloom). (3) Long term monitoring: SeaRover can be deployed for extended periods of time, allowing it to be used for longitudinal baseline studies. SeaRover will represent an advance over existing platforms in terms of: (1) Mobility: operational range from 10-1000 km, GPS accuracy, trajectory control with meter precision, and launch in hours. (2) Duration: from days up to months. (3) Payload and Power: accommodate approximately 100 kg for a 6m hull. Its surface design will allow access to wind and sun energy. (4) Communication: radio, wireless, satellite, direct data return. (5) Operational Cost: target costs are $2K/day (24 hour operation), with no onboard operator. (6) Recovery/Reusability: autonomous return to safe harbor provides sample return and on-base maintenance. Large science and power payload simplifies instrument design and integration. Enabling Technology for SeaRover - SeaRover's capabilities are made possible by advances in technologies developed during NASA planetary exploration missions: (1) Adaptive control (2) Automated data analysis (3) Communications management (4) Computer vision (5) Interactive 3D User Interfaces (6) Intelligent energy management (7) Long-duration operations planning (8) Multi-vehicle coordinated action As an example of what SeaRover could be used for, we envision augmenting existing monthly monitoring cruises in Monterey Bay with a SeaRover. Each month, the Center for Integrated Marine Technology (UC-Santa Cruz) conducts shipboard surveys of Monterey Bay. This requires 2-3 full days of ship time (weather dependent), 14 scientists, and 2 crew members. Operations are currently limited by sea-state, transit speed, and cost. SeaRover could provide all of the underway measurements and some of the hydrographic station measurements faster, more frequently, and for a fraction of the cost.

Structural Health and Prognostics Management for Offshore Wind Turbines: Sensitivity Analysis of Rotor Fault and Blade Damage with O&M Cost Modeling

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

Myrent, Noah J.; Barrett, Natalie C.; Adams, Douglas E.

2014-07-01

Operations and maintenance costs for offshore wind plants are significantly higher than the current costs for land-based (onshore) wind plants. One way to reduce these costs would be to implement a structural health and prognostic management (SHPM) system as part of a condition based maintenance paradigm with smart load management and utilize a state-based cost model to assess the economics associated with use of the SHPM system. To facilitate the development of such a system a multi-scale modeling and simulation approach developed in prior work is used to identify how the underlying physics of the system are affected by themore » presence of damage and faults, and how these changes manifest themselves in the operational response of a full turbine. This methodology was used to investigate two case studies: (1) the effects of rotor imbalance due to pitch error (aerodynamic imbalance) and mass imbalance and (2) disbond of the shear web; both on a 5-MW offshore wind turbine in the present report. Sensitivity analyses were carried out for the detection strategies of rotor imbalance and shear web disbond developed in prior work by evaluating the robustness of key measurement parameters in the presence of varying wind speeds, horizontal shear, and turbulence. Detection strategies were refined for these fault mechanisms and probabilities of detection were calculated. For all three fault mechanisms, the probability of detection was 96% or higher for the optimized wind speed ranges of the laminar, 30% horizontal shear, and 60% horizontal shear wind profiles. The revised cost model provided insight into the estimated savings in operations and maintenance costs as they relate to the characteristics of the SHPM system. The integration of the health monitoring information and O&M cost versus damage/fault severity information provides the initial steps to identify processes to reduce operations and maintenance costs for an offshore wind farm while increasing turbine availability, revenue, and overall profit.« less

Eastern Renewable Generation Integration Study

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

Bloom, Aaron; Townsend, Aaron; Palchak, David

2016-08-01

The Eastern Interconnection (EI) is one of the largest power systems in the world, and its size and complexity have historically made it difficult to study in high levels of detail in a modeling environment. In order to understand how this system might be impacted by high penetrations (30% of total annual generation) of wind and solar photovoltaic (PV) during steady state operations, the National Renewable Energy Laboratory (NREL) and the U.S. Department of Energy (DOE) conducted the Eastern Renewable Generation Integration Study (ERGIS). This study investigates certain aspects of the reliability and economic efficiency problem faced by power systemmore » operators and planners. Specifically, the study models the ability to meet electricity demand at a 5-minute time interval by scheduling resources for known ramping events, while maintaining adequate reserves to meet random variation in supply and demand, and contingency events. To measure the ability to meet these requirements, a unit commitment and economic dispatch (UC&ED) model is employed to simulate power system operations. The economic costs of managing this system are presented using production costs, a traditional UC&ED metric that does not include any consideration of long-term fixed costs. ERGIS simulated one year of power system operations to understand regional and sub-hourly impacts of wind and PV by developing a comprehensive UC&ED model of the EI. In the analysis, it is shown that, under the study assumptions, generation from approximately 400 GW of combined wind and PV capacity can be balanced on the transmission system at a 5-minute level. In order to address the significant computational burdens associated with a model of this detail we apply novel computing techniques to dramatically reduce simulation solve time while simultaneously increasing the resolution and fidelity of the analysis. Our results also indicate that high penetrations of wind and PV (collectively variable generation (VG)), significantly impact the operation of traditional generating resources and cause these resources to be used less frequently and operate across a broader output range because wind and PV have lower operating costs and variable output levels.« less

ngVLA Cryogenic Subsystem Concept

NASA Astrophysics Data System (ADS)

Wootten, Al; Urbain, Denis; Grammer, Wes; Durand, S.

2018-01-01

The VLA’s success over 35 years of operations stems in part from dramatically upgraded components over the years. The time has come to build a new array to lead the radio astronomical science into its next 40 years. To accomplish that, a next generation VLA (ngVLA) is envisioned to have 214 antennas with diameters of 18m. The core of the array will be centered at the current VLA location, but the arms will extend out to 1000km.The VLA cryogenic subsystem equipment and technology have remained virtually unchanged since the early 1980s. While adequate for a 27-antenna array, scaling the current system for an array of 214 antennas would be prohibitively expensive in terms of operating cost and maintenance. The overall goal is to limit operating cost to within three times the current level, despite having 8 times the number of antennas. To help realize this goal, broadband receivers and compact feeds will be utilized to reduce both the size and number of cryostats required. The current baseline front end concept calls for just two moderately-sized cryostats for the entire 1.2-116 GHz frequency range, as opposed to 8 in the VLA.For the ngVLA cryogenics, our objective is a well-optimized and efficient system that uses state-of-the-art technology to minimize per-antenna power consumption and maximize reliability. Application of modern technologies, such as variable-speed operation for the scroll compressors and cryocooler motor drives, allow the cooling capacity of the system to be dynamically matched to thermal loading in each cryostat. Significantly, power savings may be realized while the maintenance interval of the cryocoolers is also extended.Finally, a receiver designed to minimize thermal loading can produce savings directly translating to lower operating cost when variable-speed drives are used. Multi-layer insulation (MLI) on radiation shields and improved IR filters on feed windows can significantly reduce heat loading.Measurements done on existing cryogenic equipment show that the proposed baseline receiver concept with two cryostats, combined with variable-speed operation of the compressor and cryocoolers should allow the operating cost for ngVLA cryogenics to remain within a factor of two over the VLA.

Impact of Patient and Procedure Mix on Finances of Perinatal Centres – Theoretical Models for Economic Strategies in Perinatal Centres

PubMed Central

Hildebrandt, T.; Kraml, F.; Wagner, S.; Hack, C. C.; Thiel, F. C.; Kehl, S.; Winkler, M.; Frobenius, W.; Faschingbauer, F.; Beckmann, M. W.; Lux, M. P.

2013-01-01

Introduction: In Germany, cost and revenue structures of hospitals with defined treatment priorities are currently being discussed to identify uneconomic services. This discussion has also affected perinatal centres (PNCs) and represents a new economic challenge for PNCs. In addition to optimising the time spent in hospital, the hospital management needs to define the “best” patient mix based on costs and revenues. Method: Different theoretical models were proposed based on the cost and revenue structures of the University Perinatal Centre for Franconia (UPF). Multi-step marginal costing was then used to show the impact on operating profits of changes in services and bed occupancy rates. The current contribution margin accounting used by the UPF served as the basis for the calculations. The models demonstrated the impact of changes in services on costs and revenues of a level 1 PNC. Results: Contribution margin analysis was used to calculate profitable and unprofitable DRGs based on average inpatient cost per day. Nineteen theoretical models were created. The current direct costing used by the UPF and a theoretical model with a 100 % bed occupancy rate were used as reference models. Significantly higher operating profits could be achieved by doubling the number of profitable DRGs and halving the number of less profitable DRGs. Operating profits could be increased even more by changing the rates of profitable DRGs per bed occupancy. The exclusive specialisation on pathological and high-risk pregnancies resulted in operating losses. All models which increased the numbers of caesarean sections or focused exclusively on c-sections resulted in operating losses. Conclusion: These theoretical models offer a basis for economic planning. They illustrate the enormous impact potential changes can have on the operating profits of PNCs. Level 1 PNCs require high bed occupancy rates and a profitable patient mix to cover the extremely high costs incurred due to the services they are legally required to offer. Based on our theoretical models it must be stated that spontaneous vaginal births (not caesarean sections) were the most profitable procedures in the current DRG system. Overall, it currently makes economic sense for level I PNCs to treat as many low-risk pregnancies and neonates as possible to cover costs. PMID:24771932

A cost analysis of family planning in Bangladesh.

PubMed

Fiedler, J L; Day, L M

1997-01-01

This article presents a step-down cost analysis using secondary data sources from 26 Bangladesh non-government organizations (NGOs) providing family planning services under a US Agency for International Development-funded umbrella organization. The unit costs of the NGOs' Maternal-Child Health (MCH) clinics and community-based distribution (CBD) systems were calculated and found to be minimally different. Several simulations were conducted to investigate the impact of alternative cost-reduction measures. The more general financial analysis proved more insightful than the unit cost analysis in terms of identifying means by which to improve the efficiency of the family planning operations of these NGOs. The analysis revealed that 56 per cent of total expenditures in the two-tiered umbrella's organizational structure are incurred in management operations and overheads. Of the remaining 44 per cent of project expenditures, 39 per cent is spent on the CBD program and 5 per cent on the MCH clinics. Within the CBD program, most resources are spent providing 4 million contacts (two-thirds of the annual total) which do not involve contraceptive re-supply. The clinics devote more resources to providing MCH services than to providing family planning services. The findings suggest that significant savings could be generated by containing administrative costs, improving operational efficiency, and reducing unnecessary or redundant fieldworker contacts. The magnitude of the potential savings raises a fundamental question about the continued viability and sustainability of this supply-driven CBD strategy.

The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center.

PubMed

Mcphillamy, Austin; Gurnea, Taylor P; Moody, Alastair E; Kurnik, Christopher G; Lu, Minggen

2016-12-01

In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula. Retrospective review. Level II Trauma center. 828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures. Operative treatment with conventional or generic implants. The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period. Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used. Therapeutic Level III.

Optimal subhourly electricity resource dispatch under multiple price signals with high renewable generation availability

DOE PAGES

Chassin, David P.; Behboodi, Sahand; Djilali, Ned

2018-01-28

This article proposes a system-wide optimal resource dispatch strategy that enables a shift from a primarily energy cost-based approach, to a strategy using simultaneous price signals for energy, power and ramping behavior. A formal method to compute the optimal sub-hourly power trajectory is derived for a system when the price of energy and ramping are both significant. Optimal control functions are obtained in both time and frequency domains, and a discrete-time solution suitable for periodic feedback control systems is presented. The method is applied to North America Western Interconnection for the planning year 2024, and it is shown that anmore » optimal dispatch strategy that simultaneously considers both the cost of energy and the cost of ramping leads to significant cost savings in systems with high levels of renewable generation: the savings exceed 25% of the total system operating cost for a 50% renewables scenario.« less

Development of Low-Cost Inverted Microscope to Detect Early Growth of Mycobacterium tuberculosis in MODS Culture

PubMed Central

Zimic, Mirko; Velazco, Abner; Comina, Germán; Coronel, Jorge; Fuentes, Patricia; Luna, Carmen G.; Sheen, Patricia; Gilman, Robert H.; Moore, David A. J.

2010-01-01

Background The microscopic observation drug susceptibility (MODS) assay for rapid, low-cost detection of tuberculosis and multidrug resistant tuberculosis depends upon visualization of the characteristic cording colonies of Mycobacterium tuberculosis in liquid media. This has conventionally required an inverted light microscope in order to inspect the MODS culture plates from below. Few tuberculosis laboratories have this item and the capital cost of $5,000 for a high-end microscope could be a significant obstacle to MODS roll-out. Methodology We hypothesized that the precise definition provided by costly high-specification inverted light microscopes might not be necessary for pattern recognition. Significance In this work we describe the development of a low-cost artesenal inverted microscope that can operate in both a standard or digital mode to effectively replace the expensive commercial inverted light microscope, and an integrated system that could permit a local and remote diagnosis of tuberculosis. PMID:20351778

Optimal subhourly electricity resource dispatch under multiple price signals with high renewable generation availability

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

Chassin, David P.; Behboodi, Sahand; Djilali, Ned

This article proposes a system-wide optimal resource dispatch strategy that enables a shift from a primarily energy cost-based approach, to a strategy using simultaneous price signals for energy, power and ramping behavior. A formal method to compute the optimal sub-hourly power trajectory is derived for a system when the price of energy and ramping are both significant. Optimal control functions are obtained in both time and frequency domains, and a discrete-time solution suitable for periodic feedback control systems is presented. The method is applied to North America Western Interconnection for the planning year 2024, and it is shown that anmore » optimal dispatch strategy that simultaneously considers both the cost of energy and the cost of ramping leads to significant cost savings in systems with high levels of renewable generation: the savings exceed 25% of the total system operating cost for a 50% renewables scenario.« less

19 CFR 10.178 - Direct costs of processing operations performed in the beneficiary developing country.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Direct costs of processing operations performed in... processing operations performed in the beneficiary developing country. (a) Items included in the direct costs of processing operations. As used in § 10.176, the words “direct costs of processing operations...

A Retrospective Analysis of Direct Medical Cost and Cost of Drug Therapy in Hospitalized Patients at Private Hospital in Western India

PubMed Central

Kumbar, Shivaprasad Kalakappa

2015-01-01

Background Pharmacoeconomics is analytical tool to know cost of hospitalization and its effect on health care system and society. In India, apart from the government health services, private sector also play big role to provide health care services. Objective To study the direct medical cost and cost of drug therapy in hospitalized patients at private hospital. Materials and Methods A retrospective study was conducted at private hospital in a metro city of Western India. Total 400 patients’ billing records were selected randomly for a period from 01/01/2013 to 31/12/2014. Data were collected from medical record of hospital with permission of medical director of hospital. Patients’ demographic profile age, sex, diagnosis and various costs like ICU charge, ventilator charge, diagnostic charge, etc. were noted in previously formed case record form. Data were analysed by Z, x2 and unpaired t-test. Result Patients were divided into less than 45 years and more than 45 year age group. They were divided into medical and surgical patients according to their admission in medical or surgical ward. Mortality, Intensive Care Unit (ICU) admission, patients on ventilator were significantly (p<0.05) higher in medical patients. Direct medical cost, ward bed charge, ICU bed charge, ventilator charge and cost of drug therapy per patient were significantly (p<0.05) higher in medical patients while operation theatre and procedural charge were significantly (p<0.05) higher in surgical patients. Cost of fibrinolytics, anticoagulants, cardiovascular drugs were significantly (p<0.05) higher in medical patients. Cost of antimicrobials, proton pump inhibitors (PPIs), antiemetics, analgesics, were significantly (p<0.05) higher in surgical patients. Conclusion Ward bed charge, ICU bed charge, ventilator charge accounted more than one third cost of direct medical cost in all the patients. Cost of drug therapy was one fourth of direct medical cost. Antimicrobials cost accounted 33% of cost of drug therapy. PMID:26675983

North of the 46° parallel: Obstacles and challenges to recycling in Ontario's rural and northern communities.

PubMed

Lakhan, Calvin

2015-10-01

This study examines the economic challenges of recycling in Ontario's rural and northern areas. Specifically, this study quantifies the economic and diversion impact of operating recycling programs in these regions. Using a systems based cost model, focus is placed on analyzing: (1) What would happen to provincial recycling costs and diversion levels if recycling programs were eliminated in "high cost" northern and rural communities? (2) Is it possible to increase the provincial recycling rate by focusing investments in low cost, high performance regions (while simultaneously eliminating recycling programs in rural and northern areas)? (3) How would the mix of material recovered change if recycling programs were eliminated in rural and northern areas? The results of this analysis show that eliminating recycling programs in high cost regions significantly decreased system costs without negatively impacting overall recycling rates. This study also found that it was possible to increase the provincial recycling rate while simultaneously reducing program costs by targeting specific regions for recovery. The findings of this study suggest that Ontario reevaluate whether rural and northern municipalities be legislatively required to operate household recycling programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

How autonomy and the web are taking the people out of TacSat-2

NASA Astrophysics Data System (ADS)

Finley, Charles J.

2006-05-01

One of the most costly components of the on-orbit operation of a spacecraft is the people that execute the mission. Historically, for Air Force Research Laboratory (AFRL) and the Department of Defense Space Test Program (STP) research and development, test and evaluation (RDT&E) space missions, a team of fifteen personnel maintains 24-hour coverage for the three-week Launch and Early Operations (L/EO) phase of the mission and four one-week L/EO rehearsals. During the Nominal Operations phase of the mission, 2.5 "man-days" of support are necessary each day that the spacecraft remains on-orbit, as well as during the two, week-long, nominal operations rehearsals. Therefore, the mission-dedicated personnel contribution to the cost of a one-year mission is more than eleven man-years, and this does not include the personnel that actually operate the antennas at the various remote ground facilities or develop and maintain the mission-specific or shared-use ground network, hardware, and software. In the low-budget RDT&E world, hardware, software, or Concept of Operations (CONOPS) developments that significantly reduce the necessary Operations personnel investment can mean the difference between a mission that does or does not survive. This paper explores the CONOPS and suite of tools that the TacSat-2 program has put together to achieve maximum mission effectiveness at minimum manpower cost.

Introduction to Session 5

NASA Astrophysics Data System (ADS)

Zullo, Luca; Snyder, Seth W.

Production of bio-based products that are cost competitive in the market place requires well-developed operations that include innovative processes and separation solutions. Separations costs can make the difference between an interesting laboratory project and a successful commercial process. Bioprocessing and separations research and development addresses some of the most significant cost barriers in production of bioffuels and bio-based chemicals. Models of integrated biorefineries indicate that success will require production of higher volume fuels in conjunction with high margin chemical products. Addressing the bioprocessing and separations cost barriers will be critical to the overall success of the integrated biorefinery.

Spacecraft Onboard Software Maintenance: An Effective Approach which Reduces Costs and Increases Science Return

NASA Technical Reports Server (NTRS)

Shell, Elaine M.; Lue, Yvonne; Chu, Martha I.

1999-01-01

Flight software (FSW) is a mission critical element of spacecraft functionality and performance. When ground operations personnel interface to a spacecraft, they are dealing almost entirely with onboard software. This software, even more than ground/flight communications systems, is expected to perform perfectly at all times during all phases of on-orbit mission life. Due to the fact that FSW can be reconfigured and reprogrammed to accommodate new spacecraft conditions, the on-orbit FSW maintenance team is usually significantly responsible for the long-term success of a science mission. Failure of FSW can result in very expensive operations work-around costs and lost science opportunities. There are three basic approaches to staffing on-orbit software maintenance, namely: (1) using the original developers, (2) using mission operations personnel, or (3) assembling a Center of Excellence for multi-spacecraft on-orbit FSW support. This paper explains a National Aeronautics and Space Administration, Goddard Space Flight Center (NASA/GSFC) experience related to the roles of on-orbit FSW maintenance personnel. It identifies the advantages and disadvantages of each of the three approaches to staffing the FSW roles, and demonstrates how a cost efficient on-orbit FSW Maintenance Center of Excellence can be established and maintained with significant return on the investment.

Operating cost model for local service airlines

NASA Technical Reports Server (NTRS)

Anderson, J. L.; Andrastek, D. A.

1976-01-01

Several mathematical models now exist which determine the operating economics for a United States trunk airline. These models are valuable in assessing the impact of new aircraft into an airline's fleet. The use of a trunk airline cost model for the local service airline does not result in representative operating costs. A new model is presented which is representative of the operating conditions and resultant costs for the local service airline. The calculated annual direct and indirect operating costs for two multiequipment airlines are compared with their actual operating experience.

FRAMEWORK FOR STRUCTURAL ONLINE HEALTH MONITORING OF AGING AND DEGRADATION OF SECONDARY PIPING SYSTEMS DUE TO SOME ASPECTS OF EROSION

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

Gribok, Andrei V.; Agarwal, Vivek

This paper describes the current state of research related to critical aspects of erosion and selected aspects of degradation of secondary components in nuclear power plants (NPPs). The paper also proposes a framework for online health monitoring of aging and degradation of secondary components. The framework consists of an integrated multi-sensor modality system, which can be used to monitor different piping configurations under different degradation conditions. The report analyses the currently known degradation mechanisms and available predictive models. Based on this analysis, the structural health monitoring framework is proposed. The Light Water Reactor Sustainability Program began to evaluate technologies thatmore » could be used to perform online monitoring of piping and other secondary system structural components in commercial NPPs. These online monitoring systems have the potential to identify when a more detailed inspection is needed using real time measurements, rather than at a pre-determined inspection interval. This transition to condition-based, risk-informed automated maintenance will contribute to a significant reduction of operations and maintenance costs that account for the majority of nuclear power generation costs. Furthermore, of the operations and maintenance costs in U.S. plants, approximately 80% are labor costs. To address the issue of rising operating costs and economic viability, in 2017, companies that operate the national nuclear energy fleet started the Delivering the Nuclear Promise Initiative, which is a 3 year program aimed at maintaining operational focus, increasing value, and improving efficiency. There is unanimous agreement between industry experts and academic researchers that identifying and prioritizing inspection locations in secondary piping systems (for example, in raw water piping or diesel piping) would eliminate many excessive in-service inspections. The proposed structural health monitoring framework takes aim at answering this challenge by combining long range guided wave technologies with other monitoring techniques, which can significantly increase the inspection length and pinpoint the locations that degraded the most. More widely, the report suggests research efforts aimed at developing, validating, and deploying online corrosion monitoring techniques for complex geometries, which are pervasive in NPPs.« less

REopt Improves the Operations of Alcatraz's Solar PV-Battery-Diesel Hybrid System

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

Olis, Daniel R; Walker, H. A; Van Geet, Otto D

This poster identifies operations improvement strategies for a photovoltaic (PV)-battery-diesel hybrid system at the National Park Service's Alcatraz Island using NREL's REopt analysis tool. The current 'cycle charging' strategy results in significant curtailing of energy production from the PV array, requiring excessive diesel use, while also incurring high wear on batteries without benefit of improved efficiency. A simple 'load following' strategy results in near optimal operating cost reduction.

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

PubMed

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

2014-05-01

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

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

PubMed

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

2016-12-01

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

The latest developments and outlook for hydrogen liquefaction technology

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

Ohlig, K.; Decker, L.

2014-01-29

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

24 CFR 891.150 - Operating cost standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

... through 891.790, the operating cost standard for group homes shall be based on the number of residents... as differences in costs based on location within the field office jurisdiction. The operating cost...

Risk-Aware Planetary Rover Operation: Autonomous Terrain Classification and Path Planning

NASA Technical Reports Server (NTRS)

Ono, Masahiro; Fuchs, Thoams J.; Steffy, Amanda; Maimone, Mark; Yen, Jeng

2015-01-01

Identifying and avoiding terrain hazards (e.g., soft soil and pointy embedded rocks) are crucial for the safety of planetary rovers. This paper presents a newly developed groundbased Mars rover operation tool that mitigates risks from terrain by automatically identifying hazards on the terrain, evaluating their risks, and suggesting operators safe paths options that avoids potential risks while achieving specified goals. The tool will bring benefits to rover operations by reducing operation cost, by reducing cognitive load of rover operators, by preventing human errors, and most importantly, by significantly reducing the risk of the loss of rovers.

42 CFR 423.514 - Validation of Part D reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... that CMS requires, statistics indicating the following— (1) The cost of its operations. (2) The...) Other matters that CMS may require. (b) Significant business transactions. Each Part D plan sponsor must... authorizes an extension of time), the following: (1) A description of significant business transactions, as...

Trapped by Education: How the Discipline Became the Predominant One for Black Scholars, and What It's Costing Them

ERIC Educational Resources Information Center

Gravois, John

2007-01-01

Across the U.S., graduate students' debts have grown significantly in recent years. They have been among the first victims as state support for universities fell off in the early 2000s, as some federal grants have flatlined, as operating costs have burgeoned, and as campuswide enrollments tick upward. Among doctoral programs, money often flows…

Critical factors for sustainable food procurement in zoological collections.

PubMed

Hanson, Jonathan H

2015-01-01

Food procurement can play an important role in sustainable food supply chain management by zoos, linking organizational operations to the biodiversity conservation and sustainability mission of zoological collections. This study therefore examines the critical factors that shape sustainable food procurement in zoo and aquariums. Using a web-based survey data was collected from 41 members of the British and Irish Association of Zoos and Aquariums (BIAZA). This included information on the sustainable food procurement practices of these institutions for both their human and animal food supply chains, as well as profile information and data on the factors contributing to and inhibiting sustainable procurement practices. Zoological collections operated by charities, and those with a certified sustainability standard, were found to have significantly higher levels of sustainable food procurement. Zoos and aquariums whose human food operations were not contracted to an external party were also found to have significantly higher levels of sustainable food procurement in their human food supply chain. The most important drivers of sustainable food procurement were cost savings, adequate financial support and improved product quality. The highest ranking barriers were higher costs, other issues taking priority and a lack of alternative suppliers. The results suggest that a number of critical factors shape sustainable food procurement in zoological collections in the British Isles. Financial factors, such as cost savings, were important considerations. The significance of mission-related factors, such as charity status, indicated that core values held by zoos and aquariums can also influence their food procurement practices. © 2015 Wiley Periodicals, Inc.

Two-tier charging in Maputo Central Hospital: costs, revenues and effects on equity of access to hospital services.

PubMed

McPake, Barbara; Hongoro, Charles; Russo, Giuliano

2011-06-02

Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around. We conclude that the observed lack of transparency may create scope for an inequitable cross subsidy of private customers by public resources.

Evaluation of a protocol-based intervention to promote timely switching from intravenous to oral paracetamol for post-operative pain management: an interrupted time series analysis.

PubMed

Sabry, Nirmeen; Dawoud, Dalia; Alansary, Adel; Hounsome, Natalia; Baines, Darrin

2015-12-01

Timely switching from intravenous to oral therapy ensures optimized treatment and efficient use of health care resources. Intravenous (IV) paracetamol is widely used for post-operative pain management but not always switched to the oral form in a timely manner, leading to unnecessary increase in expenditure. This study aims to evaluate the impact of a multifaceted intervention to promote timely switching from the IV to oral form in the post-operative setting. An evidence-based prescribing protocol was designed and implemented by the clinical pharmacy team in a single district general hospital in Egypt. The protocol specified the criteria for appropriate prescribing of IV paracetamol. Doctors were provided with information and educational sessions prior to implementation. A prospective, quasi-experimental study was undertaken to evaluate its impact on IV paracetamol utilization and costs. Data on monthly utilization and costs were recorded for 12 months before and after implementation (January 2012 to December 2013). Data were analysed using interrupted time series analysis. Prior to implementation, in 2012, total spending on IV paracetamol was 674 154.00 Egyptian Pounds (L.E.) ($23,668.00). There was a non-significant (P > 0.05) downward trend in utilization (-32 ampoules per month) and costs [reduction of 632 L.E. ($222) per month]. Following implementation, immediate decrease in utilization and costs (P < 0.05) and a trend change over the follow-up period were observed. Average monthly reduction was 26% (95% CI: 24% to 28%, P < 0.001). A multifaceted, protocol-based intervention to ensure timely switching from IV-to-oral paracetamol achieved significant reduction in utilization and cost of IV paracetamol in the first 5 months of its implementation. © 2015 John Wiley & Sons, Ltd.

41 CFR 102-33.190 - What are the aircraft operations and ownership costs for which we must account?

Code of Federal Regulations, 2010 CFR

2010-07-01

... operations and ownership costs for which we must account? 102-33.190 Section 102-33.190 Public Contracts and... Parts Accounting for the Cost of Government Aircraft § 102-33.190 What are the aircraft operations and ownership costs for which we must account? You must account for the operations and ownership costs of your...

High temperature process steam application at the Southern Union Refining Company, Hobbs, New Mexico. Solar energy in the oil patch. Final report, Phase III: operation, maintenance, and performance

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

Wilson, L.E.; McGuire, D.R.

1984-05-01

This final report summarizes the technical reports for Phase III of this project. The third phase included the operation, maintenance, upgrade and performance reporting of a 10,080 square foot Solar Industrial Process Heat System installed at the Famariss Energy Refinery of Southern Union Refining Company near Hobbs, New Mexico. This report contains a description of the upgraded system, and a summary of the overall operation, maintenance and performance of the installed system. The results of the upgrade activities can be seen in the last two months of operational data. Steam production was significantly greater in peak flow and monthly totalmore » than at any previous time. Also monthly total cost savings was greatly improved even though natural gas costs remain much lower than originally anticipated.« less

Aircraft operability methods applied to space launch vehicles

NASA Astrophysics Data System (ADS)

Young, Douglas

1997-01-01

The commercial space launch market requirement for low vehicle operations costs necessitates the application of methods and technologies developed and proven for complex aircraft systems. The ``building in'' of reliability and maintainability, which is applied extensively in the aircraft industry, has yet to be applied to the maximum extent possible on launch vehicles. Use of vehicle system and structural health monitoring, automated ground systems and diagnostic design methods derived from aircraft applications support the goal of achieving low cost launch vehicle operations. Transforming these operability techniques to space applications where diagnostic effectiveness has significantly different metrics is critical to the success of future launch systems. These concepts will be discussed with reference to broad launch vehicle applicability. Lessons learned and techniques used in the adaptation of these methods will be outlined drawing from recent aircraft programs and implementation on phase 1 of the X-33/RLV technology development program.

Cost effectiveness of robotic mitral valve surgery.

PubMed

Moss, Emmanuel; Halkos, Michael E

2017-01-01

Significant technological advances have led to an impressive evolution in mitral valve surgery over the last two decades, allowing surgeons to safely perform less invasive operations through the right chest. Most new technology comes with an increased upfront cost that must be measured against postoperative savings and other advantages such as decreased perioperative complications, faster recovery, and earlier return to preoperative level of functioning. The Da Vinci robot is an example of such a technology, combining the significant benefits of minimally invasive surgery with a "gold standard" valve repair. Although some have reported that robotic surgery is associated with increased overall costs, there is literature suggesting that efficient perioperative care and shorter lengths of stay can offset the increased capital and intraoperative expenses. While data on current cost is important to consider, one must also take into account future potential value resulting from technological advancement when evaluating cost-effectiveness. Future refinements that will facilitate more effective surgery, coupled with declining cost of technology will further increase the value of robotic surgery compared to traditional approaches.

Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon's experience: a cost analysis covering the initial 50 robotic cases with the da Vinci Si.

PubMed

Morelli, Luca; Guadagni, Simone; Lorenzoni, Valentina; Di Franco, Gregorio; Cobuccio, Luigi; Palmeri, Matteo; Caprili, Giovanni; D'Isidoro, Cristiano; Moglia, Andrea; Ferrari, Vincenzo; Di Candio, Giulio; Mosca, Franco; Turchetti, Giuseppe

2016-09-01

The aim of this study is to compare surgical parameters and the costs of robotic surgery with those of laparoscopic approach in rectal cancer based on a single surgeon's early robotic experience. Data from 25 laparoscopic (LapTME) and the first 50 robotic (RobTME) rectal resections performed at our institution by an experienced laparoscopic surgeon (>100 procedures) between 2009 and 2014 were retrospectively analyzed and compared. Patient demographic, procedure, and outcome data were gathered. Costs of the two procedures were collected, differentiated into fixed and variable costs, and analyzed against the robotic learning curve according to the cumulative sum (CUSUM) method. Based on CUSUM analysis, RobTME group was divided into three phases (Rob1: 1-19; Rob2: 20-40; Rob3: 41-50). Overall median operative time (OT) was significantly lower in LapTME than in RobTME (270 vs 312.5 min, p = 0.006). A statistically significant change in OT by phase of robotic experience was detected in the RobTME group (p = 0.010). Overall mean costs associated with LapTME procedures were significantly lower than with RobTME (p < 0.001). Statistically significant reductions in variable and overall costs were found between robotic phases (p < 0.009 for both). With fixed costs excluded, the difference between laparoscopic and Rob3 was no longer statistically significant. Our results suggest a significant optimization of robotic rectal surgery's costs with experience. Efforts to reduce the dominant fixed cost are recommended to maintain the sustainability of the system and benefit from the technical advantages offered by the robot.

Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness.

PubMed

Polignano, Francesco M; Quyn, Aaron J; de Figueiredo, Rodrigo S M; Henderson, Nikola A; Kulli, Christoph; Tait, Iain S

2008-12-01

Reduction in hospital stay, blood loss, postoperative pain and complications are common findings after laparoscopic liver resection, suggesting that the laparoscopic approach may be a suitable alternative to open surgery. Some concerns have been raised regarding cost effectiveness of this procedure and potential implications of its large-scale application. Our aim has been to determine cost effectiveness of laparoscopic liver surgery by a case-matched, case-control, intention-to-treat analysis of its costs and short-term clinical outcomes compared with open surgery. Laparoscopic liver segmentectomies and bisegmentectomies performed at Ninewells Hospital and Medical School between 2005 and 2007 were considered. Resections involving more than two Couinaud segments, or involving any synchronous procedure, were excluded. An operation-magnitude-matched control group was identified amongst open liver resections performed between 2004 and 2007. Hospital costs were obtained from the Scottish Health Service Costs Book (ISD Scotland) and average national costs were calculated. Cost of theatre time, disposable surgical devices, hospital stay, and high-dependency unit (HDU) and intensive care unit (ICU) usage were the main endpoints for comparison. Secondary endpoints were morbidity and mortality. Statistical analysis was performed with Student's t-test, chi(2) and Fisher exact test as most appropriate. Twenty-five laparoscopic liver resections were considered, including atypical resection, segmentectomy and bisegmentectomy, and they were compared to 25 matching open resections. The two groups were homogeneous by age, sex, coexistent morbidity, magnitude of resection, prevalence of liver cirrhosis and indications. Operative time (p < 0.03), blood loss (p < 0.0001), Pringle manoeuvre (p < 0.03), hospital stay (p < 0.003) and postoperative complications (p < 0.002) were significantly reduced in the laparoscopic group. Overall hospital cost was significantly lower in the laparoscopic group by an average of 2,571 pounds sterling (p < 0.04). Laparoscopic liver segmentectomy and bisegmentectomy are feasible, safe and cost effective compared to similar open resections. Large-scale application of laparoscopic liver surgery could translate into significant savings to hospitals and health care programmes.

Determination of optimum allocation and pricing of distributed generation using genetic algorithm methodology

NASA Astrophysics Data System (ADS)

Mwakabuta, Ndaga Stanslaus

Electric power distribution systems play a significant role in providing continuous and "quality" electrical energy to different classes of customers. In the context of the present restrictions on transmission system expansions and the new paradigm of "open and shared" infrastructure, new approaches to distribution system analyses, economic and operational decision-making need investigation. This dissertation includes three layers of distribution system investigations. In the basic level, improved linear models are shown to offer significant advantages over previous models for advanced analysis. In the intermediate level, the improved model is applied to solve the traditional problem of operating cost minimization using capacitors and voltage regulators. In the advanced level, an artificial intelligence technique is applied to minimize cost under Distributed Generation injection from private vendors. Soft computing techniques are finding increasing applications in solving optimization problems in large and complex practical systems. The dissertation focuses on Genetic Algorithm for investigating the economic aspects of distributed generation penetration without compromising the operational security of the distribution system. The work presents a methodology for determining the optimal pricing of distributed generation that would help utilities make a decision on how to operate their system economically. This would enable modular and flexible investments that have real benefits to the electric distribution system. Improved reliability for both customers and the distribution system in general, reduced environmental impacts, increased efficiency of energy use, and reduced costs of energy services are some advantages.

Local or General Anesthesia for Open Hernia Repair: A Randomized Trial

PubMed Central

O’Dwyer, Patrick J.; Serpell, Michael G.; Millar, Keith; Paterson, Caron; Young, David; Hair, Alan; Courtney, Carol-Ann; Horgan, Paul; Kumar, Sudhir; Walker, Andrew; Ford, Ian

2003-01-01

Objective To compare patient outcome following repair of a primary groin hernia under local (LA) or general anesthesia (GA) in a randomized clinical trial. Summary Background Data LA hernia repair is thought to be safer for patients, causes less postoperative pain, cost less, and is associated with a more rapid recovery when compared with the same operation performed under GA. Methods All patients presenting to three surgeons during the study period with a primary groin hernia were considered eligible. Outcome parameters measured including tests of vigilance, divided attention, sustained attention, memory, cognitive function, pain, return to normal activity, and costs. Results Two hundred seventy-nine patients were randomized to LA or GA hernia repair; 276 of these had an operation, with 138 participants in each group. At 6, 24, and 72 hours postoperatively there were no differences in vigilance or divided attention between the groups. Similarly, memory, sustained attention, and cognitive function were not impaired in either group. Although physical activity was significantly impaired at 24 hours, this and return to usual social activities were similar in both groups. While patients in the LA group had significantly less pain on moving, at 6 hours they were less likely to recommend the same operation to someone else. GA hernia repair cost 4% more than the same operation under LA. Conclusions There are no major differences in patient recovery after LA or GA hernia repair. Patients should be offered a choice of anesthesia, LA or GA, for repair of their groin hernia. PMID:12677155

Association Between Patient-Centered Medical Home Rating and Operating Cost at Federally Funded Health Centers

PubMed Central

Nocon, Robert S.; Sharma, Ravi; Birnberg, Jonathan M.; Ngo-Metzger, Quyen; Lee, Sang Mee; Chin, Marshall H.

2013-01-01

Context Little is known about the cost associated with a health center’s rating as a patient-centered medical home (PCMH). Objective To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Design, Setting, and Participants Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Main Outcome Measures Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Results Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD,12; range, 21–90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86–$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27 300; 95% CI,$3047–$57 804) and higher operating cost per patient per month ($1.06;95%CI,$0.29–$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32 731; 95% CI, $1571–$73 670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54–$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39 809; 95% CI, $1893–$63 169). Conclusions According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost. PMID:22729481

Cost estimation and analysis using the Sherpa Automated Mine Cost Engineering System

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

Stebbins, P.E.

1993-09-01

The Sherpa Automated Mine Cost Engineering System is a menu-driven software package designed to estimate capital and operating costs for proposed surface mining operations. The program is engineering (as opposed to statistically) based, meaning that all equipment, manpower, and supply requirements are determined from deposit geology, project design and mine production information using standard engineering techniques. These requirements are used in conjunction with equipment, supply, and labor cost databases internal to the program to estimate all associated costs. Because virtually all on-site cost parameters are interrelated within the program, Sherpa provides an efficient means of examining the impact of changesmore » in the equipment mix on total capital and operating costs. If any aspect of the operation is changed, Sherpa immediately adjusts all related aspects as necessary. For instance, if the user wishes to examine the cost ramifications of selecting larger trucks, the program not only considers truck purchase and operation costs, it also automatically and immediately adjusts excavator requirements, operator and mechanic needs, repair facility size, haul road construction and maintenance costs, and ancillary equipment specifications.« less

Open vs Laparoscopic Simple Prostatectomy: A Comparison of Initial Outcomes and Cost.

PubMed

Demir, Aslan; Günseren, Kadir Ömür; Kordan, Yakup; Yavaşçaoğlu, İsmet; Vuruşkan, Berna Aytaç; Vuruşkan, Hakan

2016-08-01

We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP). A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically. No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Qmax), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Qmax values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount, and Qmax values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.

ISS Operations Cost Reductions Through Automation of Real-Time Planning Tasks

NASA Technical Reports Server (NTRS)

Hall, Timothy A.

2011-01-01

In 2008 the Johnson Space Center s Mission Operations Directorate (MOD) management team challenged their organization to find ways to reduce the costs of International Space station (ISS) console operations in the Mission Control Center (MCC). Each MOD organization was asked to identify projects that would help them attain a goal of a 30% reduction in operating costs by 2012. The MOD Operations and Planning organization responded to this challenge by launching several software automation projects that would allow them to greatly improve ISS console operations and reduce staffing and operating costs. These projects to date have allowed the MOD Operations organization to remove one full time (7 x 24 x 365) ISS console position in 2010; with the plan of eliminating two full time ISS console support positions by 2012. This will account for an overall 10 EP reduction in staffing for the Operations and Planning organization. These automation projects focused on utilizing software to automate many administrative and often repetitive tasks involved with processing ISS planning and daily operations information. This information was exchanged between the ground flight control teams in Houston and around the globe, as well as with the ISS astronaut crew. These tasks ranged from managing mission plan changes from around the globe, to uploading and downloading information to and from the ISS crew, to even more complex tasks that required multiple decision points to process the data, track approvals and deliver it to the correct recipient across network and security boundaries. The software solutions leveraged several different technologies including customized web applications and implementation of industry standard web services architecture between several planning tools; as well as a engaging a previously research level technology (TRL 2-3) developed by Ames Research Center (ARC) that utilized an intelligent agent based system to manage and automate file traffic flow, archiving f data, and generating console logs. This technology called OCAMS (OCA (Orbital Communication System) Management System), is now considered TRL level 9 and is in daily use in the Mission Control Center in support of ISS operations. These solutions have not only allowed for improved efficiency on console; but since many of the previously manual data transfers are now automated, many of the human error prone steps have been removed, and the quality of the planning products has improved tremendously. This has also allowed our Planning Flight Controllers more time to focus on the abstract areas of the job, (like the complexities of planning a mission for 6 international crew members with a global planning team), instead of being burdened with the administrative tasks that took significant time each console shift to process. The resulting automation solutions have allowed the Operations and Planning organization to realize significant cost savings for the ISS program through 2020 and many of these solutions could be a viable

42 CFR 417.930 - Initial costs of operation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Initial costs of operation. 417.930 Section 417.930... PREPAYMENT PLANS Administration of Outstanding Loans and Loan Guarantees § 417.930 Initial costs of operation. Under section 1305 of the PHS, loans and loan guarantees were awarded for initial costs of operation of...

Minimum Nurse Staffing Legislation and the Financial Performance of California Hospitals

PubMed Central

Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

2012-01-01

Objective To estimate the effect of minimum nurse staffing ratios on California acute care hospitals’ financial performance. Data Sources/Study Setting Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. Study Design The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1 = lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Data Collection/Extraction Methods Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Principal Findings Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Conclusions Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. PMID:22150627

What Are the Most Significant Cost and Value Drivers for Pancreatic Resection in an Integrated Healthcare System?

PubMed

Vuong, Brooke; Dehal, Ahmed; Uppal, Abhineet; Stern, Stacey L; Mejia, Juan; Weerasinghe, Roshanthi; Kapoor, Vandana; Ong, Evan; Hansen, Paul D; Bilchik, Anton J

2018-03-23

An initiative was established to improve value-based care for pancreatic surgery in a large nonprofit health system. Cost data were presented bimonthly to a hepatobiliary clinical performance group via videoconference. The direct costs were calculated for all patients undergoing distal pancreatectomy (DP) and pancreaticoduodenectomy (PD) between January 2014 and July 2017. Median length of stay, 30-day and 90-day mortality rates, readmission rate, and costs were stratified by surgeon volume using 2 published criteria: "volume pledge" criteria (≥5 PDs/year) and Leapfrog criteria (≥11 PDs/year). There were 270 DPs and 526 PDs performed in 14 hospitals spanning 4 states. Median PD costs were lower for high-volume surgeons (≥5 PDs/year), $21,026 vs $24,706 (p = 0.005). High-volume surgeons had a shorter length of stay (9 days vs 11 days; p < 0.001) for PD and DP (6 days vs 7 days; p = 0.001). Increased costs for low-volume surgeons included operative/anesthesia costs ($7,321 vs $6,325; p = 0.03), room and board ($5,828 vs $4,580; p = 0.01), and intensive care costs ($4,464 vs $3,113; p = 0.04). Operating time was increased for high-volume surgeons for DP and PD (p < 0.001). There was no difference in 30-day or 90-day mortality rates or readmissions for DP or PD when stratified by volume pledge criteria. There was no difference in total costs for DP or PD when stratified by Leapfrog criteria. There was a significant cost reduction for PD but not DP when the threshold of 5 PDs was used as a definition of high volume. The sharing of detailed financial data with HPB surgeons on a regular basis provides an opportunity to evaluate practice patterns and thereby reduce direct costs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Efficacy of a proactive health and safety risk management system in the fire service.

PubMed

Poplin, Gerald S; Griffin, Stephanie; Pollack Porter, Keshia; Mallett, Joshua; Hu, Chengcheng; Day-Nash, Virginia; Burgess, Jefferey L

2018-04-16

This study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs. Injury data were collected for the intervention fire department and a contemporary control department. Workers' compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments. There was a post-intervention average annual reduction in injuries (13%), workers' compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department. Reduced workers' compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant.

Intelligent Life-Extending Controls for Aircraft Engines

NASA Technical Reports Server (NTRS)

Guo, Ten-Huei; Chen, Philip; Jaw, Link

2005-01-01

Aircraft engine controllers are designed and operated to provide desired performance and stability margins. The purpose of life-extending-control (LEC) is to study the relationship between control action and engine component life usage, and to design an intelligent control algorithm to provide proper trade-offs between performance and engine life usage. The benefit of this approach is that it is expected to maintain safety while minimizing the overall operating costs. With the advances of computer technology, engine operation models, and damage physics, it is necessary to reevaluate the control strategy fro overall operating cost consideration. This paper uses the thermo-mechanical fatigue (TMF) of a critical component to demonstrate how an intelligent engine control algorithm can drastically reduce the engine life usage with minimum sacrifice in performance. A Monte Carlo simulation is also performed to evaluate the likely engine damage accumulation under various operating conditions. The simulation results show that an optimized acceleration schedule can provide a significant life saving in selected engine components.

Comparison of particle swarm optimization and differential evolution for aggregators' profit maximization in the demand response system

NASA Astrophysics Data System (ADS)

Wisittipanit, Nuttachat; Wisittipanich, Warisa

2018-07-01

Demand response (DR) refers to changes in the electricity use patterns of end-users in response to incentive payment designed to prompt lower electricity use during peak periods. Typically, there are three players in the DR system: an electric utility operator, a set of aggregators and a set of end-users. The DR model used in this study aims to minimize the operator's operational cost and offer rewards to aggregators, while profit-maximizing aggregators compete to sell DR services to the operator and provide compensation to end-users for altering their consumption profiles. This article presents the first application of two metaheuristics in the DR system: particle swarm optimization (PSO) and differential evolution (DE). The objective is to optimize the incentive payments during various periods to satisfy all stakeholders. The results show that DE significantly outperforms PSO, since it can attain better compensation rates, lower operational costs and higher aggregator profits.

A practical tool for modeling biospecimen user fees.

PubMed

Matzke, Lise; Dee, Simon; Bartlett, John; Damaraju, Sambasivarao; Graham, Kathryn; Johnston, Randal; Mes-Masson, Anne-Marie; Murphy, Leigh; Shepherd, Lois; Schacter, Brent; Watson, Peter H

2014-08-01

The question of how best to attribute the unit costs of the annotated biospecimen product that is provided to a research user is a common issue for many biobanks. Some of the factors influencing user fees are capital and operating costs, internal and external demand and market competition, and moral standards that dictate that fees must have an ethical basis. It is therefore important to establish a transparent and accurate costing tool that can be utilized by biobanks and aid them in establishing biospecimen user fees. To address this issue, we built a biospecimen user fee calculator tool, accessible online at www.biobanking.org . The tool was built to allow input of: i) annual operating and capital costs; ii) costs categorized by the major core biobanking operations; iii) specimen products requested by a biobank user; and iv) services provided by the biobank beyond core operations (e.g., histology, tissue micro-array); as well as v) several user defined variables to allow the calculator to be adapted to different biobank operational designs. To establish default values for variables within the calculator, we first surveyed the members of the Canadian Tumour Repository Network (CTRNet) management committee. We then enrolled four different participants from CTRNet biobanks to test the hypothesis that the calculator tool could change approaches to user fees. Participants were first asked to estimate user fee pricing for three hypothetical user scenarios based on their biobanking experience (estimated pricing) and then to calculate fees for the same scenarios using the calculator tool (calculated pricing). Results demonstrated significant variation in estimated pricing that was reduced by calculated pricing, and that higher user fees are consistently derived when using the calculator. We conclude that adoption of this online calculator for user fee determination is an important first step towards harmonization and realistic user fees.

Effects of network node consolidation in optical access and aggregation networks on costs and power consumption

NASA Astrophysics Data System (ADS)

Lange, Christoph; Hülsermann, Ralf; Kosiankowski, Dirk; Geilhardt, Frank; Gladisch, Andreas

2010-01-01

The increasing demand for higher bit rates in access networks requires fiber deployment closer to the subscriber resulting in fiber-to-the-home (FTTH) access networks. Besides higher access bit rates optical access network infrastructure and related technologies enable the network operator to establish larger service areas resulting in a simplified network structure with a lower number of network nodes. By changing the network structure network operators want to benefit from a changed network cost structure by decreasing in short and mid term the upfront investments for network equipment due to concentration effects as well as by reducing the energy costs due to a higher energy efficiency of large network sites housing a high amount of network equipment. In long term also savings in operational expenditures (OpEx) due to the closing of central office (CO) sites are expected. In this paper different architectures for optical access networks basing on state-of-the-art technology are analyzed with respect to network installation costs and power consumption in the context of access node consolidation. Network planning and dimensioning results are calculated for a realistic network scenario of Germany. All node consolidation scenarios are compared against a gigabit capable passive optical network (GPON) based FTTH access network operated from the conventional CO sites. The results show that a moderate reduction of the number of access nodes may be beneficial since in that case the capital expenditures (CapEx) do not rise extraordinarily and savings in OpEx related to the access nodes are expected. The total power consumption does not change significantly with decreasing number of access nodes but clustering effects enable a more energyefficient network operation and optimized power purchase order quantities leading to benefits in energy costs.

Critical operations capabilities in a high cost environment: a multiple case study

NASA Astrophysics Data System (ADS)

Sansone, C.; Hilletofth, P.; Eriksson, D.

2018-04-01

Operations capabilities have been a popular research area for many years and several frameworks have been proposed in the literature. The current frameworks do not take specific contexts into consideration, for instance a high cost environment. This research gap is of particular interest since a manufacturing relocation process has been ongoing the last decades, leading to a huge amount of manufacturing being moved from high to low cost environments. The purpose of this study is to identify critical operations capabilities in a high cost environment. The two research questions were: What are the critical operations capabilities dimensions in a high cost environment? What are the critical operations capabilities in a high cost environment? A multiple case study was conducted and three Swedish manufacturing firms were selected. The study was based on the investigation of an existing framework of operations capabilities. The main dimensions of operations capabilities included in the framework were: cost, quality, delivery, flexibility, service, innovation and environment. Each of the dimensions included two or more operations capabilities. The findings confirmed the validity of the framework and its usefulness in a high cost environment and a new operations capability was revealed (employee flexibility).

Modeling Operations Costs for Human Exploration Architectures

NASA Technical Reports Server (NTRS)

Shishko, Robert

2013-01-01

Operations and support (O&S) costs for human spaceflight have not received the same attention in the cost estimating community as have development costs. This is unfortunate as O&S costs typically comprise a majority of life-cycle costs (LCC) in such programs as the International Space Station (ISS) and the now-cancelled Constellation Program. Recognizing this, the Constellation Program and NASA HQs supported the development of an O&S cost model specifically for human spaceflight. This model, known as the Exploration Architectures Operations Cost Model (ExAOCM), provided the operations cost estimates for a variety of alternative human missions to the moon, Mars, and Near-Earth Objects (NEOs) in architectural studies. ExAOCM is philosophically based on the DoD Architecture Framework (DoDAF) concepts of operational nodes, systems, operational functions, and milestones. This paper presents some of the historical background surrounding the development of the model, and discusses the underlying structure, its unusual user interface, and lastly, previous examples of its use in the aforementioned architectural studies.

Estimating airline operating costs

NASA Technical Reports Server (NTRS)

Maddalon, D. V.

1978-01-01

A review was made of the factors affecting commercial aircraft operating and delay costs. From this work, an airline operating cost model was developed which includes a method for estimating the labor and material costs of individual airframe maintenance systems. The model, similar in some respects to the standard Air Transport Association of America (ATA) Direct Operating Cost Model, permits estimates of aircraft-related costs not now included in the standard ATA model (e.g., aircraft service, landing fees, flight attendants, and control fees). A study of the cost of aircraft delay was also made and a method for estimating the cost of certain types of airline delay is described.

Rapid evolution of air sensor technologies

EPA Science Inventory

Outdoor air pollution measurement approaches have historically been conducted using stationary shelters that require significant space, power, and expertise to operate. The cost and logistical requirements to conduct monitoring have limited the number of locations with continuou...

Fleet equipment performance measure preventive maintenance model.

DOT National Transportation Integrated Search

2013-02-28

The Texas Department of Transportation : (TxDOT) operates a large fleet of on-road and : off-road equipment. Consequently, fleet : maintenance procedures (specifically preventive : maintenance such as oil changes) represent a : significant cost to th...

Laser Balancing

NASA Technical Reports Server (NTRS)

1981-01-01

Mechanical Technology, Incorporated developed a fully automatic laser machining process that allows more precise balancing removes metal faster, eliminates excess metal removal and other operator induced inaccuracies, and provides significant reduction in balancing time. Manufacturing costs are reduced as a result.

Total systems design analysis of high performance structures

NASA Technical Reports Server (NTRS)

Verderaime, V.

1993-01-01

Designer-control parameters were identified at interdiscipline interfaces to optimize structural systems performance and downstream development and operations with reliability and least life-cycle cost. Interface tasks and iterations are tracked through a matrix of performance disciplines integration versus manufacturing, verification, and operations interactions for a total system design analysis. Performance integration tasks include shapes, sizes, environments, and materials. Integrity integrating tasks are reliability and recurring structural costs. Significant interface designer control parameters were noted as shapes, dimensions, probability range factors, and cost. Structural failure concept is presented, and first-order reliability and deterministic methods, benefits, and limitations are discussed. A deterministic reliability technique combining benefits of both is proposed for static structures which is also timely and economically verifiable. Though launch vehicle environments were primarily considered, the system design process is applicable to any surface system using its own unique filed environments.

Impact of youth injuries on the uninsured farm family's economic viability.

PubMed

Zaloshnja, Eduard; Miller, Ted R

2012-01-01

The objective of this study is to estimate the impact of youth injuries on the uninsured farm family's economic viability. Using farm prototypes, we compared farm profits with costs of farm youth injuries. We built profit models for two types of farms, dairy and soybean farms. Then we estimated the cost impact of farm youth injuries of different levels of severity on a farm family with no health insurance. A severe child injury that requires at least 10 days of hospitalisation would cost almost equal to the operating profit of the average dairy farm with no health insurance and would turn the operating profit of the average soybean farm into a severe loss of $99,499. Prevention of child agricultural injuries would significantly improve the financial situation for farm families that lack health insurance.

Retransmission of hydrometric data in Canada

NASA Technical Reports Server (NTRS)

Halliday, R. A. (Principal Investigator); Reid, I. A.

1978-01-01

The author has identified the following significant results. The LANDSAT program has demonstrated that polar orbiting satellites can be used to relay hydrologic data from any part of Canada to a user without difficulty and at low cost. These data can be used for many operational purposes, the most important of which were identified as follows: hydroelectric power plant operation; water supply for municipalities, industries, and irrigation; navigation; flood forecasting; operation of flood control structures and systems; and recreation.

O/S analysis of conceptual space vehicles. Part 1

NASA Technical Reports Server (NTRS)

Ebeling, Charles E.

1995-01-01

The application of recently developed computer models in determining operational capabilities and support requirements during the conceptual design of proposed space systems is discussed. The models used are the reliability and maintainability (R&M) model, the maintenance simulation model, and the operations and support (O&S) cost model. In the process of applying these models, the R&M and O&S cost models were updated. The more significant enhancements include (1) improved R&M equations for the tank subsystems, (2) the ability to allocate schedule maintenance by subsystem, (3) redefined spares calculations, (4) computing a weighted average of the working days and mission days per month, (5) the use of a position manning factor, and (6) the incorporation into the O&S model of new formulas for computing depot and organizational recurring and nonrecurring training costs and documentation costs, and depot support equipment costs. The case study used is based upon a winged, single-stage, vertical-takeoff vehicle (SSV) designed to deliver to the Space Station Freedom (SSF) a 25,000 lb payload including passengers without a crew.

U.S. healthcare fix: leveraging the lessons from the food supply chain.

PubMed

Kumar, Sameer; Blair, John T

2013-01-01

U.S. healthcare costs consistently outpace inflation, causing growing problems of affordability. This trend cannot be sustained indefinitely. The purpose of this study is to use supply-chain tools for macro-level examination of the U.S. healthcare as a business system and identify options and best use practices. We compare the important and successful U.S. food industry to the essential but problematic U.S. healthcare industry. Supply chain strategies leading to food business operations success are examined and healthcare applications suggested. We emphasize "total cost of ownership" which includes all costs incurred by all stakeholders of U.S. healthcare, including maintenance and cleanup, not just the initial purchase price. U.S. hospitals and clinics can use supply chain strategies in a total cost of ownership framework to reduce healthcare costs while maintaining patient care quality. Supply chain strategies of resource pooling, mass customization, centralized logistics, specialization, postponement and continuous improvement that have been successfully used in the U.S. food industry should be more widely applied to the U.S. healthcare industry. New and growing areas of telemedicine and medical tourism should be included in the supply chain analysis of U.S. healthcare. Valid statistical analysis of results in all areas of U.S. healthcare is an important part of the process. U.S. healthcare industry problems are systematic operational and supply chain problems rather than problems with workforce or technology. Examination of the U.S. healthcare industry through a supply chain framework should lead to significant operational improvement in both prevention and treatment of acute and chronic ailments. A rational and unemotional reorganization of the U.S. healthcare system operations, using supply chain strategies, should help reduce healthcare costs while maintaining quality and increasing accessibility.

Cost of enlarged operating zone for an existing Francis runner

NASA Astrophysics Data System (ADS)

Monette, Christine; Marmont, Hugues; Chamberland-Lauzon, Joël; Skagerstrand, Anders; Coutu, André; Carlevi, Jens

2016-11-01

Traditionally, hydro power plants have been operated close to best efficiency point, the more stable operating condition for which they have been designed. However, because of changes in the electricity market, many hydro power plants operators wish to operate their machines differently to fulfil those new market needs. New operating conditions can include whole range operation, many start/stops, extensive low load operation, synchronous condenser mode and power/frequency regulation. Many of these new operating conditions may impose more severe fatigue damage than the traditional base load operation close to best efficiency point. Under these conditions, the fatigue life of the runner may be significantly reduced and reparation or replacement cost might occur sooner than expected. In order to design reliable Francis runners for those new challenging operating scenarios, Andritz Hydro has developed various proprietary tools and design rules. These are used within Andritz Hydro to design mechanically robust Francis runners for the operating scenarios fulfilling customer's specifications. To estimate residual life under different operating scenarios of an existing runner designed years ago for best efficiency base load operation, Andritz Hydro's design rules and tools would necessarily lead to conservative results. While the geometry of a new runner can be modified to fulfil all conservative mechanical design rules, the predicted fatigue life of an existing runner under off-design operating conditions may appear rather short because of the conservative safety factor included in the calculations. The most precise and reliable way to calculate residual life of an existing runner under different operating scenarios is to perform a strain gauge measurement campaign on the runner. This paper presents the runner strain gage measurement campaign of a mid-head Francis turbine over all the operating conditions available during the test, the analysis of the measurement signals and the runner residual life assessment under different operating scenarios. With these results, the maintenance cost of the change in operating mode can then be calculated and foreseen by the power plant owner.

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

PubMed

Patiño-Echeverri, Dalia; Hoppock, David C

2012-01-17

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

Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care.

PubMed

Schwarzbach, Matthias H M; Ronellenfitsch, Ulrich; Wang, Qian; Rössner, Eric D; Denz, Christof; Post, Stefan; Hohenberger, Peter

2010-04-01

The purpose of this study was to evaluate effects of a clinical pathway (CP) for video-assisted thoracoscopic surgery (VATS) on process quality, outcome quality, and hospital costs. We implemented a CP for VATS and compared 34 patients treated with CP to 77 patients treated without CP. Indicators for process quality were duration of catheter placement, pain intensity, respiratory exercising, and mobilization. Outcome quality was measured through morbidity, mortality, reoperations, and readmissions. Cost of hospital stay was calculated using an imputed daily rate. Foley catheters were removed significantly earlier after CP implementation. All patients on CP were mobilized and received pulmonary exercising on the operation day. Pain levels were low after CP implementation. Median hospital stay significantly reduced by 5 days. Perioperative outcome quality remained unchanged. Costs significantly diminished by 1,510 Euro per stay. CP implementation had positive effects on process quality. Specifically, catheter management was improved and a good pain control achieved. Patients benefited from shortened stay and were treated at lower cost. A clear effect on outcome quality was not found. CPs are a promising tool for quality improvement and cost containment in thoracic surgery.

Implications of Using Computer-Based Training with the AN/SQQ-89(v) Sonar System: Operating and Support Costs

DTIC Science & Technology

2012-06-01

Visibility and Management of Operating and Support Costs (VAMOSC...VAMOSC Visibility and Management of Operating and Support Costs VMA Variant Manning Average WAP Weapons Alternate Processor WCS Work Center...Visibility and Management of Operating and Support Costs (VAMOSC), under Unit Level Consumption and Manhours—Organizational Corrective Maintenance. C

25 CFR 39.201 - Does ISEF reflect the actual cost of school operations?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Does ISEF reflect the actual cost of school operations... Does ISEF reflect the actual cost of school operations? ISEF does not attempt to assess the actual cost of school operations either at the local school level or in the aggregate nationally. ISEF is a...

25 CFR 39.101 - Does ISEF assess the actual cost of school operations?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Does ISEF assess the actual cost of school operations? 39... SCHOOL EQUALIZATION PROGRAM Indian School Equalization Formula § 39.101 Does ISEF assess the actual cost of school operations? No. ISEF does not attempt to assess the actual cost of school operations either...

Low-Cost, Light Weight, Thin Film Solar Concentrator

NASA Technical Reports Server (NTRS)

Ganapathi, G.; Palisoc, A.; Nesmith, B.; Greschik, G.; Gidanian, K.; Kindler, A.

2013-01-01

This research addresses a cost barrier towards achieving a solar thermal collector system with an installed cost of $75/sq m and meet the Department of Energy's (DOE's) performance targets for optical errors, operations during windy conditions and lifetime. Current concentrators can cost as much as 40-50% of the total installed costs for a CSP plant. In order to reduce the costs from current $200-$250/sq m, it is important to focus on the overall system. The reflector surface is a key cost driver, and our film-based polymer reflector will help significantly in achieving DOE's cost target of $75/sq m. The ease of manufacturability, installation and replacement make this technology a compelling one to develop. This technology can be easily modified for a variety of CSP options including heliostats, parabolic dishes and parabolic troughs.

Laparoscopic resection for diverticular disease.

PubMed

Bruce, C J; Coller, J A; Murray, J J; Schoetz, D J; Roberts, P L; Rusin, L C

1996-10-01

The role of laparoscopic surgery in treatment of patients with diverticulitis is unclear. A retrospective comparison of laparoscopic with conventional surgery for patients with chronic diverticulitis was performed to assess morbidity, recovery from surgery, and cost. Records of patients undergoing elective resection for uncomplicated diverticulitis from 1992 to 1994 at a single institution were reviewed. Laparoscopic resection involved complete intracorporeal dissection, bowel division, and anastomosis with extracorporeal placement of an anvil. Sigmoid and left colon resections were performed laparoscopically in 25 patients and by open technique in 17 patients by two independent operating teams. No significant differences existed in age, gender, weight, comorbidities, or operations performed. In the laparoscopic group, three operations were converted to open laparotomy (12 percent) because of unclear anatomy. Major complications occurred in two patients who underwent laparoscopic resection, both requiring laparotomy, and in one patient in the conventional surgery group who underwent computed tomographic-guided drainage of an abscess. Patients who underwent laparoscopic resection tolerated a regular diet sooner than patients who underwent conventional surgery (3.2 +/- 0.9 vs. 5.7 +/- 1.1 days; P < 0.001) and were discharged from the hospital earlier (4.2 +/- 1.1 vs. 6.8 +/- 1.1 days; P < 0.001). Overall costs were higher in the laparoscopic group than the open surgery group ($10,230 +/- 49.1 vs. $7,068 +/- 37.1; P < 0.001) because of a significantly longer total operating room time (397 +/- 9.1 vs. 115 +/- 5.1 min; P < 0.001). Follow-up studies with a mean of one year revealed two port site infections in the laparoscopic group and one wound infection in the open group. Of patients undergoing conventional resection, one patient experienced a postoperative bowel obstruction that was managed nonoperatively, and, in one patient, an incarcerated incisional hernia developed that required urgent laparotomy. Laparoscopic resection in patients with chronic diverticulitis is safe, with faster recovery and shorter hospital stay compared with conventional open surgery. Higher cost of operating room usage time makes the laparoscopic technique difficult to justify economically. Simplification of operating room use and better case selection may improve cost-effectiveness of the laparoscopic approach.

Improving HVAC operational efficiency in small-and medium-size commercial buildings

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

Kim, Woohyun; Katipamula, Srinivas; Lutes, Robert

Small- and medium-size (<100,000 sf) commercial buildings (SMBs) represent over 95% of the U.S. commercial building stock and consume over 60% of total site energy consumption. Many of these buildings use rudimentary controls that are mostly manual, with limited scheduling capability, no monitoring, or failure management. Therefore, many of these buildings are operated inefficiently and consume excess energy. SMBs typically use packaged rooftop units (RTUs) that are controlled by an individual thermostat. There is increased urgency to improve the operating efficiency of existing commercial building stock in the United States for many reasons, chief among them being to mitigate themore » climate change impacts. Studies have shown that managing set points and schedules of the RTUs will result in up to 20% energy and cost savings. Another problem associated with RTUs is short cycling, when an RTU goes through ON and OFF cycles too frequently. Excessive cycling can lead to excessive wear and to premature failure of the compressor or its components. Also, short cycling can result in a significantly decreased average efficiency (up to 10%), even if there are no physical failures in the equipment. Ensuring correct use of the zone set points and eliminating frequent cycling of RTUs thereby leading to persistent building operations can significantly increase the operational efficiency of the SMBs. A growing trend is to use low-cost control infrastructure that can enable scalable and cost-effective intelligent building operations. The work reported in this paper describes two algorithms for detecting the zone set point temperature and RTU cycling rate that can be deployed on the low-cost infrastructure. These algorithms only require the zone temperature data for detection. The algorithms have been tested and validated using field data from a number of RTUs from six buildings in different climate locations. Overall, the algorithms were successful in detecting the set points and ON/OFF cycles accurately using the peak detection technique. The paper describes the two algorithms, results from testing the algorithms using field data, how the algorithms can be used to improve SMBs efficiency, and presents related conclusions.« less

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

PubMed

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

2014-10-01

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

Laparoscopic and abdominal hysterectomy: a cost comparison.

PubMed

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

1997-02-17

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

Don't overlook disease management programs for low-incidence, high-cost diseases to improve your bottom line.

PubMed

Bruce, D; Dickmeyer, J

2001-01-01

Comprehensive coordinated care management for low-incident, high-cost diseases, like chronic renal failure, can provide a great opportunity for health plans to add immediate and significant profit to their bottom line. The resultant benefits of improved operations, improved clinical outcomes and increased patient satisfaction add further incentive for health plans to take action to implement outsourced disease management for this condition.

Multifunction Multiband Airborne Radio Architecture Study.

DTIC Science & Technology

1982-01-01

30 to 88, 108 to 156, and 255 to 400 MHz band allocations . (ii) On designated operating channels: two in the 225 to 400 MHz bandwidth, one in each of...altimeter, direction finding, and relay. 2.2 BASELINE SYSTEM APPROACH This subsection describes the TRW-proposed baseline design for the MFBARS system...problem and SINCGARS application. Major efforts were directed toward reducing the overall costs while retaining required performance. Significantly, cost

Estimating Airline Operating Costs

NASA Technical Reports Server (NTRS)

Maddalon, D. V.

1978-01-01

The factors affecting commercial aircraft operating and delay costs were used to develop an airline operating cost model which includes a method for estimating the labor and material costs of individual airframe maintenance systems. The model permits estimates of aircraft related costs, i.e., aircraft service, landing fees, flight attendants, and control fees. A method for estimating the costs of certain types of airline delay is also described.

Initial Costs vs. Operational Costs. A Study of Building Improvement Projects in Fourteen Schools in the School District of Greenville County, South Carolina.

ERIC Educational Resources Information Center

Chan, Tak Cheung

To determine whether initial facility improvement costs were paid back by the reduced operational costs resulting from the improvement projects, this study examined the relationship between initial costs and operational costs of fourteen school buildings improved during the 1978-79 school year in Greenville County, South Carolina. With energy…

Control of dispatch dynamics for lowering the cost of distributed generation in the built environment

NASA Astrophysics Data System (ADS)

Flores, Robert Joseph

Distributed generation can provide many benefits over traditional central generation such as increased reliability and efficiency while reducing emissions. Despite these potential benefits, distributed generation is generally not purchased unless it reduces energy costs. Economic dispatch strategies can be designed such that distributed generation technologies reduce overall facility energy costs. In this thesis, a microturbine generator is dispatched using different economic control strategies, reducing the cost of energy to the facility. Several industrial and commercial facilities are simulated using acquired electrical, heating, and cooling load data. Industrial and commercial utility rate structures are modeled after Southern California Edison and Southern California Gas Company tariffs and used to find energy costs for the simulated buildings and corresponding microturbine dispatch. Using these control strategies, building models, and utility rate models, a parametric study examining various generator characteristics is performed. An economic assessment of the distributed generation is then performed for both the microturbine generator and parametric study. Without the ability to export electricity to the grid, the economic value of distributed generation is limited to reducing the individual costs that make up the cost of energy for a building. Any economic dispatch strategy must be built to reduce these individual costs. While the ability of distributed generation to reduce cost depends of factors such as electrical efficiency and operations and maintenance cost, the building energy demand being serviced has a strong effect on cost reduction. Buildings with low load factors can accept distributed generation with higher operating costs (low electrical efficiency and/or high operations and maintenance cost) due to the value of demand reduction. As load factor increases, lower operating cost generators are desired due to a larger portion of the building load being met in an effort to reduce demand. In addition, buildings with large thermal demand have access to the least expensive natural gas, lowering the cost of operating distributed generation. Recovery of exhaust heat from DG reduces cost only if the buildings thermal demand coincides with the electrical demand. Capacity limits exist where annual savings from operation of distributed generation decrease if further generation is installed. For low operating cost generators, the approximate limit is the average building load. This limit decreases as operating costs increase. In addition, a high capital cost of distributed generation can be accepted if generator operating costs are low. As generator operating costs increase, capital cost must decrease if a positive economic performance is desired.

Cost study : before, during and after AOS implementation (October 1996 - May 1999)

DOT National Transportation Integrated Search

This study compared AATA operating costs over two different time periods: before and during AOS installation. While neither additional operating costs nor operating costs savings were traceable to AOS at this time, the implications of this report, wh...

76 FR 30925 - Information Collection; Submission for OMB Review, Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

.../startup): None. Total Burden Cost (operating/maintenance): None. Instrument: Application and Budget.../startup): None. Total Burden Cost (operating/maintenance): None. AmeriCorps\\*\\VISTA Project Progress...,800 hours. Total Burden Cost (capital/startup): None. Total Burden Cost (operating/maintenance): None...

Business intelligence modeling in launch operations

NASA Astrophysics Data System (ADS)

Bardina, Jorge E.; Thirumalainambi, Rajkumar; Davis, Rodney D.

2005-05-01

The future of business intelligence in space exploration will focus on the intelligent system-of-systems real-time enterprise. In present business intelligence, a number of technologies that are most relevant to space exploration are experiencing the greatest change. Emerging patterns of set of processes rather than organizational units leading to end-to-end automation is becoming a major objective of enterprise information technology. The cost element is a leading factor of future exploration systems. This technology project is to advance an integrated Planning and Management Simulation Model for evaluation of risks, costs, and reliability of launch systems from Earth to Orbit for Space Exploration. The approach builds on research done in the NASA ARC/KSC developed Virtual Test Bed (VTB) to integrate architectural, operations process, and mission simulations for the purpose of evaluating enterprise level strategies to reduce cost, improve systems operability, and reduce mission risks. The objectives are to understand the interdependency of architecture and process on recurring launch cost of operations, provide management a tool for assessing systems safety and dependability versus cost, and leverage lessons learned and empirical models from Shuttle and International Space Station to validate models applied to Exploration. The systems-of-systems concept is built to balance the conflicting objectives of safety, reliability, and process strategy in order to achieve long term sustainability. A planning and analysis test bed is needed for evaluation of enterprise level options and strategies for transit and launch systems as well as surface and orbital systems. This environment can also support agency simulation based acquisition process objectives. The technology development approach is based on the collaborative effort set forth in the VTB's integrating operations, process models, systems and environment models, and cost models as a comprehensive disciplined enterprise analysis environment. Significant emphasis is being placed on adapting root cause from existing Shuttle operations to exploration. Technical challenges include cost model validation, integration of parametric models with discrete event process and systems simulations, and large-scale simulation integration. The enterprise architecture is required for coherent integration of systems models. It will also require a plan for evolution over the life of the program. The proposed technology will produce long-term benefits in support of the NASA objectives for simulation based acquisition, will improve the ability to assess architectural options verses safety/risk for future exploration systems, and will facilitate incorporation of operability as a systems design consideration, reducing overall life cycle cost for future systems.

Business Intelligence Modeling in Launch Operations

NASA Technical Reports Server (NTRS)

Bardina, Jorge E.; Thirumalainambi, Rajkumar; Davis, Rodney D.

2005-01-01

This technology project is to advance an integrated Planning and Management Simulation Model for evaluation of risks, costs, and reliability of launch systems from Earth to Orbit for Space Exploration. The approach builds on research done in the NASA ARC/KSC developed Virtual Test Bed (VTB) to integrate architectural, operations process, and mission simulations for the purpose of evaluating enterprise level strategies to reduce cost, improve systems operability, and reduce mission risks. The objectives are to understand the interdependency of architecture and process on recurring launch cost of operations, provide management a tool for assessing systems safety and dependability versus cost, and leverage lessons learned and empirical models from Shuttle and International Space Station to validate models applied to Exploration. The systems-of-systems concept is built to balance the conflicting objectives of safety, reliability, and process strategy in order to achieve long term sustainability. A planning and analysis test bed is needed for evaluation of enterprise level options and strategies for transit and launch systems as well as surface and orbital systems. This environment can also support agency simulation .based acquisition process objectives. The technology development approach is based on the collaborative effort set forth in the VTB's integrating operations. process models, systems and environment models, and cost models as a comprehensive disciplined enterprise analysis environment. Significant emphasis is being placed on adapting root cause from existing Shuttle operations to exploration. Technical challenges include cost model validation, integration of parametric models with discrete event process and systems simulations. and large-scale simulation integration. The enterprise architecture is required for coherent integration of systems models. It will also require a plan for evolution over the life of the program. The proposed technology will produce long-term benefits in support of the NASA objectives for simulation based acquisition, will improve the ability to assess architectural options verses safety/risk for future exploration systems, and will facilitate incorporation of operability as a systems design consideration, reducing overall life cycle cost for future systems. The future of business intelligence of space exploration will focus on the intelligent system-of-systems real-time enterprise. In present business intelligence, a number of technologies that are most relevant to space exploration are experiencing the greatest change. Emerging patterns of set of processes rather than organizational units leading to end-to-end automation is becoming a major objective of enterprise information technology. The cost element is a leading factor of future exploration systems.

Greening the Grid: Pathways to Integrate 175 Gigawatts of Renewable Energy into India’s Electric Grid, Vol. 1. National Study

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

Palchak, David; Cochran, Jaquelin; Deshmukh, Ranjit

The use of renewable energy (RE) sources, primarily wind and solar generation, is poised to grow significantly within the Indian power system. The Government of India has established a target of 175 gigawatts (GW) of installed RE capacity by 2022, including 60 GW of wind and 100 GW of solar, up from 29 GW wind and 9 GW solar at the beginning of 2017. Using advanced weather and power system modeling made for this project, the study team is able to explore operational impacts of meeting India’s RE targets and identify actions that may be favorable for integration. Our primarymore » tool is a detailed production cost model, which simulates optimal scheduling and dispatch of available generation in a future year (2022) by minimizing total production costs subject to physical, operational, and market constraints. Our team comprises a core group from the Power System Operation Corporation, Ltd. (POSOCO), which is the national grid operator (with representation from the National, Southern, and Western Regional Load Dispatch Centers) under Ministry of Power, National Renewable Energy Laboratory (NREL), and Lawrence Berkeley National Laboratory (Berkeley Lab), and a broader modeling team that includes Central Electricity Authority (CEA), POWERGRID (the central transmission utility, CTU), and State Load Dispatch Centers in Maharashtra, Gujarat, Tamil Nadu, Karnataka, Rajasthan, and Andhra Pradesh. Our model includes high-resolution wind and solar data (forecasts and actuals), unique properties for each generator, CEA/CTU’s anticipated buildout of the power system, and enforced state-to-state transmission flows. Assuming the fulfillment of current efforts to provide better access to the physical flexibility of the power system, we find that power system balancing with 100 GW of solar and 60 GW of wind is achievable at 15-minute operational timescales with minimal RE curtailment. This RE capacity meets 22% of total projected 2022 electricity consumption in India with annual RE curtailment of 1.4%, in line with experiences in other countries with significant RE penetrations (Bird et al. 2016). Changes to operational practice can further reduce the cost of operating the power system and reduce RE curtailment. Coordinating scheduling and dispatch over a broader area is the largest driver to reduce costs, saving INR 6300 crore (USD 980 million) annually when optimized regionally. Lowering minimum operating levels of coal plants (from 70% to 40%) is the biggest driver to reduce RE curtailment—from 3.5% down to 0.76%. In fact, this operating property is more influential than faster thermal generation ramp rates in lowering the projected levels of curtailment. While this study does not answer every question relevant to planning for India’s 2022 RE targets, it is an important step toward analyzing operational challenges and cost saving opportunities using state-of-the-art power system planning tools. Further analysis can build upon this basis to explore optimal renewable resource and intrastate transmission siting, system stability during contingencies, and the influence of total power system investment costs on customer tariffs.« less

Greening the Grid: Pathways to Integrate 175 Gigawatts of Renewable Energy into India's Electric Grid, Vol. I -- National Study

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

Palchak, David; Cochran, Jaquelin; Ehlen, Ali

The use of renewable energy (RE) sources, primarily wind and solar generation, is poised to grow significantly within the Indian power system. The Government of India has established a target of 175 gigawatts (GW) of installed RE capacity by 2022, including 60 GW of wind and 100 GW of solar, up from 29 GW wind and 9 GW solar at the beginning of 2017. Thanks to advanced weather and power system modeling made for this project, the study team is able to explore operational impacts of meeting India's RE targets and identify actions that may be favorable for integration. Ourmore » primary tool is a detailed production cost model, which simulates optimal scheduling and dispatch of available generation in a future year (2022) by minimizing total production costs subject to physical, operational, and market constraints. Our team comprises a core group from the Power System Operation Corporation, Ltd. (POSOCO), which is the national grid operator (with representation from the National, Southern, and Western Regional Load Dispatch Centers) under Ministry of Power, National Renewable Energy Laboratory (NREL), and Lawrence Berkeley National Laboratory (LBNL), and a broader modeling team that includes Central Electricity Authority (CEA), POWERGRID (the central transmission utility, CTU), and State Load Dispatch Centers in Maharashtra, Gujarat, Tamil Nadu, Karnataka, Rajasthan, and Andhra Pradesh. Our model includes high-resolution wind and solar data (forecasts and actuals), unique properties for each generator, CEA/CTU's anticipated buildout of the power system, and enforced state-to-state transmission flows. Assuming the fulfillment of current efforts to provide better access to the physical flexibility of the power system, we find that power system balancing with 100 GW of solar and 60 GW of wind is achievable at 15-minute operational timescales with minimal RE curtailment. This RE capacity meets 22% of total projected 2022 electricity consumption in India with annual RE curtailment of 1.4%, in line with experiences in other countries with significant RE penetrations (Bird et al. 2016). Changes to operational practice can further reduce the cost of operating the power system and reduce RE curtailment. Coordinating scheduling and dispatch over a broader area is the largest driver to reduce costs, saving INR 6300 crore (USD $920 million) annually when optimized regionally. Lowering minimum operating levels of coal plants (from 70% to 40%) is the biggest driver to reduce RE curtailment - from 3.5% down to 0.76%. In fact, this operating property is more influential than faster thermal generation ramp rates in lowering the projected levels of curtailment. While this study does not answer every question relevant to planning for India's 2022 RE targets, it is an important step toward analyzing operational challenges and cost saving opportunities using state-of-the-art power system planning tools. Further analysis can build upon this basis to explore optimal renewable resource and intrastate transmission siting, system stability during contingencies, and the influence of total power system investment costs on customer tariffs.« less

Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma

PubMed Central

Zheng, Min-Hua; Feng, Bo; Lu, Ai-Guo; Li, Jian-Wen; Wang, Ming-Liang; Mao, Zhi-Hai; Hu, Yan-Yan; Dong, Feng; Hu, Wei-Guo; Li, Dong-Hua; Zang, Lu; Peng, Yuan-Fei; Yu, Bao-Ming

2005-01-01

AIM: Laparoscopic surgery, especially laparoscopic rectal surgery, for colorectal cancer has been developed considerably. However, due to relatively complicated anatomy and high requirements for surgery techniques, laparoscopic right colectomy develops relatively slowly. This study was designed to compare the outcomes of laparoscopic right hemicolectomy (LRH) with open right hemicolectomy (ORH) in the treatment of colon carcinoma. METHODS: Between September 2000 and February 2003, 30 patients with colon cancer who underwent LRH were compared with 34 controls treated by ORH in the same period. All patients were evaluated with respect to surgery-related complications, postoperative recovery, recurrence and metastasis rate, cost-effectiveness and survival. RESULTS: Among 30 LRH, 2 (6.7%) were converted to open procedure. No significant differences were observed in terms of mean operation time, blood loss, post-operative complications, and hospital cost between LRH and ORH groups. Mean time for bowel movement, hospital stay, and time to resume early activity in the LRH group were significantly shorter than those in the ORH group (2.24±0.56 vs 3.25±1.29 d, 13.94±6.5 vs 18.25±5.96 d, 3.94±1.64 vs 5.45±1.82 d respectively, P<0.05). As to the lymph node yield, the specimen length and total cost for operation and drugs, there was no significant difference between the two groups. Local recurrence rate and metachronous metastasis rate had no marked difference between the two groups. Cumulative survival probability at 40 mo in LRH group (76.50%) was not obviously different compared to the ORH group (74.04%). CONCLUSION: LRH in patients with colon cancer has statistically and clinically significant advantages over ORH. Thus, LRH can be regarded as a safe and effective procedure. PMID:15637736

Laparoscopic transhiatal esophagectomy improves hospital outcomes and reduces cost: a single-institution analysis of laparoscopic-assisted and open techniques.

PubMed

Ecker, Brett L; Savulionyte, Goda E; Datta, Jashodeep; Dumon, Kristoffel R; Kucharczuk, John; Williams, Noel N; Dempsey, Daniel T

2016-06-01

Several case series have demonstrated that laparoscopic transhiatal esophagectomy (LTHE) is associated with favorable perioperative outcomes compared to historical data for open transhiatal esophagectomy (OTHE). Contemporaneous evaluation of open and laparoscopic THE is rare, limiting meaningful comparison of techniques. All patients who underwent OTHE (n = 32) and LTHE (n = 41) during the introduction of the latter procedure at our institution (1/2012-4/2014) were identified, and patient charts were retrospectively reviewed. Indications for operation included 69 patients with esophageal malignancy (adenocarcinoma: 64; squamous cell carcinoma: 4; melanoma: 1) and 4 patients with benign disease. There were no significant differences in clinicopathologic variables between OTHE and LTHE cohorts, except for an increased rate of cardiovascular disease in the LTHE cohort (p = 0.04). There was no significant difference in median operative time or operative complications, yet LTHE was associated with a lower incidence of intraoperative blood transfusion (p < 0.01). There were no 30-day mortalities. LTHE was associated with a reduced time to reach 24-h tube feeding goals (p = 0.02), shorter length of hospital stay (p = 0.01), and 6 % reduced median direct cost (p = 0.04). There were no significant differences in rates of major perioperative morbidities. Patients were followed for a median of 11.0 months during which there were no significant differences between cohorts in disease-free survival or overall survival. When compared to OTHE, LTHE improves surgical outcomes and decreases hospital costs; short-term oncologic outcomes are similar. LTHE is preferable to OTHE in patients requiring transhiatal esophagectomy.

Overseas Contingency Operations: OMB and DOD Should Revise the Criteria for Determining Eligible Costs and Identify the Costs Likely to Endure Long Term

DTIC Science & Technology

2017-01-01

OVERSEAS CONTINGENCY OPERATIONS OMB and DOD Should Revise the Criteria for Determining Eligible Costs and Identify the... CONTINGENCY OPERATIONS OMB and DOD Should Revise the Criteria for Determining Eligible Costs and Identify the Costs Likely to Endure Long Term Why GAO...billion in funding for OCO. While DOD’s OCO budget request has included amounts for contingency operations primarily in Iraq and Afghanistan, more

Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

PubMed Central

Jenkins, Paul J; McDonald, David A; Van Der Meer, Robert; Morton, Alec; Nugent, Margaret; Rymaszewski, Lech A

2017-01-01

Objective Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC). Setting The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome measures Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models. Results Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway. Conclusions Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings. PMID:28882905

Vehicle operating costs, fuel consumption, and pavement type condition factors

DOT National Transportation Integrated Search

1982-06-01

This report presents updated vehicle operating cost tables which may be used by a highway agency for estimation of vehicle operating costs as a function of operational and roadway variables. These results, partially based on fuel consumption tests on...

19 CFR 10.197 - Direct costs of processing operations performed in a beneficiary country or countries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Direct costs of processing operations performed in... TO A REDUCED RATE, ETC. Caribbean Basin Initiative § 10.197 Direct costs of processing operations... operations. As used in § 10.195 and § 10.198, the words “direct costs of processing operations” mean those...

43 CFR 404.40 - What is the non-Federal share of operation, maintenance, and replacement costs?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Cost-Sharing § 404.40 What is the non-Federal share of operation, maintenance, and replacement costs? You are required to pay 100 percent of the operation, maintenance, and replacement costs of any rural... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What is the non-Federal share of operation...

Harmonic scalpel versus electrocautery in breast reduction surgery: a randomized controlled trial.

PubMed

Burdette, Todd E; Kerrigan, Carolyn L; Homa, Karen; Homa, Karen A

2011-10-01

The authors hypothesized that the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio) might outperform electrocautery in bilateral breast reduction surgery, possibly resulting in (1) shorter operative times, (2) lower postoperative fluid drainage rates, and (3) reduced postoperative pain scores. Thirty-one patients were evaluated in a matched-pair design, with random (blinded) assignment of one side to the Harmonic Scalpel, with the other side defaulting to electrocautery. Main outcome measures were: (1) resection/hemostasis time, (2) drainage volume, and (3) postoperative pain. The authors also compared the learning curves, operative time versus specimen weights, complications, and costs for the devices. There was a statistically significant (but not clinically significant) difference between the median times for the Harmonic Scalpel (33 minutes) and electrocautery (31 minutes) (p=0.02). There was no statistical difference in drainage scores, and pain scores were equivalent. The analysis of specimen weight versus resection/hemostasis time showed no correlation. There were more complications on the breasts reduced with the Harmonic device, but due to the small sample size, the complication results were not statistically significant. Start-up costs for the devices were comparable, but the per-procedure cost for the Harmonic device was considerably higher. The Harmonic Scalpel is roughly equivalent to electrocautery in breast reduction surgery in terms of resection/hemostasis time, serous drainage, and postoperative pain. Though the Harmonic device may be excellent for other surgical procedures, its high cost suggests that surgeons and institutions can confidently forgo its use in breast reduction surgery. Therapeutic, II.

Development of a Two-Stage Microalgae Dewatering Process – A Life Cycle Assessment Approach

PubMed Central

Soomro, Rizwan R.; Zeng, Xianhai; Lu, Yinghua; Lin, Lu; Danquah, Michael K.

2016-01-01

Even though microalgal biomass is leading the third generation biofuel research, significant effort is required to establish an economically viable commercial-scale microalgal biofuel production system. Whilst a significant amount of work has been reported on large-scale cultivation of microalgae using photo-bioreactors and pond systems, research focus on establishing high performance downstream dewatering operations for large-scale processing under optimal economy is limited. The enormous amount of energy and associated cost required for dewatering large-volume microalgal cultures has been the primary hindrance to the development of the needed biomass quantity for industrial-scale microalgal biofuels production. The extremely dilute nature of large-volume microalgal suspension and the small size of microalgae cells in suspension create a significant processing cost during dewatering and this has raised major concerns towards the economic success of commercial-scale microalgal biofuel production as an alternative to conventional petroleum fuels. This article reports an effective framework to assess the performance of different dewatering technologies as the basis to establish an effective two-stage dewatering system. Bioflocculation coupled with tangential flow filtration (TFF) emerged a promising technique with total energy input of 0.041 kWh, 0.05 kg CO2 emissions and a cost of $ 0.0043 for producing 1 kg of microalgae biomass. A streamlined process for operational analysis of two-stage microalgae dewatering technique, encompassing energy input, carbon dioxide emission, and process cost, is presented. PMID:26904075

NREL: News - Hybrid Buses Operate With Lower Emissions, Greater Fuel

Science.gov Websites

Evaluation Project to collect fueling, maintenance, performance and emission data from NYCT. While the hybrid buses have greater fuel economy than diesel buses, maintenance costs were significantly higher due in

A comparison of the costs of laparoscopic myomectomy and open myomectomy at a teaching hospital in southern Taiwan.

PubMed

Chang, Chi-Chang

2013-06-01

To compare the costs of traditional open myomectomy (OM) with laparoscopic myomectomy (LM). A retrospective review was conducted of the medical records of 155 women who underwent traditional open myomectomy (OM) or laparoscopic myomectomy (LM) in a teaching hospital in Taiwan. The total medical service expense and the patient out-of-pocket expense were significantly higher for women who received LM than for women who received OM. However, the operative time and blood loss during surgery were significantly less in women who received LM than in women who received OM. The overall expense is higher for LM than for OM; however, the laparoscopic approach has numerous advantages for patients, including shorter operative time, less blood loss, and a more rapid recovery time. No difference existed in the rate of complications or in the recurrence of disease for the two procedures. Copyright © 2013. Published by Elsevier B.V.

The hospital cost of road traffic accidents at a South African regional trauma centre: a micro-costing study.

PubMed

Parkinson, F; Kent, S J W; Aldous, C; Oosthuizen, G; Clarke, D

2014-01-01

Road traffic crashes are responsible for a vast amount of death and disability in developing countries. This study uses a bottom up, micro-costing approach to determine the cost of road traffic related crashes in South Africa. Using the data from one hundred consecutive RTC related admissions to a regional hospital in South Africa we performed a bottom up costing study. To calculate costs patients were reviewed every 48 h and all interventions were recorded for each individual patient. Prices of interventions were obtained from hospital pricelists. A total cost was calculated on an individual basis. The total cost of in-patient care for these patients was US $6,98,850. Upper limb injuries were the most expensive, and the total cost increased with the number of body regions injured. The biggest expenditure was on ward overheads ($2,81,681). Ninety operations were performed - the total cost of theatre time was $1,48,230 and the cost of orthopaedic implants was $1,26,487. The cost of care of a RTC victim is significant. In light of the high numbers of RTC victims admitted over the course of the year this is a significant cost burden for a regional hospital to bear. This cost must be taken into account when allocating hospital budgets. Copyright © 2013 Elsevier Ltd. All rights reserved.

Consumer-Operated Service Programs: monetary and donated costs and cost-effectiveness.

PubMed

Yates, Brian T; Mannix, Danyelle; Freed, Michael C; Campbell, Jean; Johnsen, Matthew; Jones, Kristine; Blyler, Crystal R

2011-01-01

Examine cost differences between Consumer Operated Service Programs (COSPs) as possibly determined by a) size of program, b) use of volunteers and other donated resources, c) cost-of-living differences between program locales, d) COSP model applied, and e) delivery system used to implement the COSP model. As part of a larger evaluation of COSP, data on operating costs, enrollments, and mobilization of donated resources were collected for eight programs representing three COSP models (drop-in centers, mutual support, and education/advocacy training). Because the 8 programs were operated in geographically diverse areas of the US, costs were examined with and without adjustment for differences in local cost of living. Because some COSPs use volunteers and other donated resources, costs were measured with and without these resources being monetized. Scale of operation also was considered as a mediating variable for differences in program costs. Cost per visit, cost per consumer per quarter, and total program cost were calculated separately for funds spent and for resources donated for each COSP. Differences between COSPs in cost per consumer and cost per visit seem better explained by economies of scale and delivery system used than by cost-of-living differences between program locations or COSP model. Given others' findings that different COSP models produce little variation in service effectiveness, minimize service costs by maximizing scale of operation while using a delivery system that allows staff and facilities resources to be increased or decreased quickly to match number of consumers seeking services.

Influence of design on cost of operating airplanes

NASA Technical Reports Server (NTRS)

Black, Archibald

1922-01-01

The author discusses cost of operating commercial airplanes and endeavors to clear up prevalent misunderstandings. Curves of operating cost for varying duration, speed, reserve horsepower, etc. are developed.

Levelized cost of energy (LCOE) metric to characterize solar absorber coatings for the CSP industry

DOE PAGES

Boubault, Antoine; Ho, Clifford K.; Hall, Aaron; ...

2015-07-08

The contribution of each component of a power generation plant to the levelized cost of energy (LCOE) can be estimated and used to increase the power output while reducing system operation and maintenance costs. The LCOE is used in order to quantify solar receiver coating influence on the LCOE of solar power towers. Two new parameters are introduced: the absolute levelized cost of coating (LCOC) and the LCOC efficiency. Depending on the material properties, aging, costs, and temperature, the absolute LCOC enables quantifying the cost-effectiveness of absorber coatings, as well as finding optimal operating conditions. The absolute LCOC is investigatedmore » for different hypothetic coatings and is demonstrated on Pyromark 2500 paint. Results show that absorber coatings yield lower LCOE values in most cases, even at significant costs. Optimal reapplication intervals range from one to five years. At receiver temperatures greater than 700 °C, non-selective coatings are not always worthwhile while durable selective coatings consistently reduce the LCOE—up to 12% of the value obtained for an uncoated receiver. Moreover the absolute LCOC is a powerful tool to characterize and compare different coatings, not only considering their initial efficiencies but also including their durability.« less

``Big Bang" for NASA's Buck: Nearly Three Years of EUVE Mission Operations at UCB

NASA Astrophysics Data System (ADS)

Stroozas, B. A.; Nevitt, R.; McDonald, K. E.; Cullison, J.; Malina, R. F.

1999-12-01

After over seven years in orbit, NASA's Extreme Ultraviolet Explorer (EUVE) satellite continues to perform flawlessly and with no significant loss of science capabilities. EUVE continues to produce important and exciting science results and, with reentry not expected until 2003-2004, many more such discoveries await. In the nearly three years since the outsourcing of EUVE from NASA's Goddard Space Flight Center, the small EUVE operations team at the University of California at Berkeley (UCB) has successfully conducted all aspects of the EUVE mission -- from satellite operations, science and mission planning, and data processing, delivery, and archival, to software support, systems administration, science management, and overall mission direction. This paper discusses UCB's continued focus on automation and streamlining, in all aspects of the Project, as the means to maximize EUVE's overall scientific productivity while minimizing costs. Multitasking, non-traditional work roles, and risk management have led to expanded observing capabilities while achieving significant cost reductions and maintaining the mission's historical 99 return. This work was funded under NASA Cooperative Agreement NCC5-138.

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

Hummon, M.; Kiliccote, S.

Demand response (DR) resources present a potentially important source of grid flexibility however, DR in grid models is limited by data availability and modeling complexity. This presentation focuses on the co-optimization of DR resources to provide energy and ancillary services in a production cost model of the Colorado "test system". We assume each DR resource can provide energy services by either shedding load or shifting its use between different times, as well as operating reserves: frequency regulation, contingency reserve, and flexibility (or ramping) reserve. There are significant variations in the availabilities of different types of DR resources, which affect bothmore » the operational savings as well as the revenue for each DR resource. The results presented include the system-wide avoided fuel and generator start-up costs as well as the composite revenue for each DR resource by energy and operating reserves.« less

Proven Innovations and New Initiatives in Ground System Development: Reducing Costs in the Ground System

NASA Technical Reports Server (NTRS)

Gunn, Jody M.

2006-01-01

The state-of-the-practice for engineering and development of Ground Systems has evolved significantly over the past half decade. Missions that challenge ground system developers with significantly reduced budgets in spite of requirements for greater and previously unimagined functionality are now the norm. Making the right trades early in the mission lifecycle is one of the key factors to minimizing ground system costs. The Mission Operations Strategic Leadership Team at the Jet Propulsion Laboratory has spent the last year collecting and working through successes and failures in ground systems for application to future missions.

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

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

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

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

Cost analysis in laccase production.

PubMed

Osma, Johann F; Toca-Herrera, José L; Rodríguez-Couto, Susana

2011-11-01

In this paper the cost of producing the enzyme laccase by the white-rot fungus Trametes pubescens under both submerged (SmF) and solid-state fermentation (SSF) conditions was studied. The fungus was cultured using more than 45 culture medium compositions. The cost of production was estimated by analyzing the cost of the culture medium, the cost of equipment and the operating costs. The cost of the culture medium represented, in all cases, the highest contribution to the total cost, while, the cost of equipment was significantly low, representing less than 2% of the total costs. The cultivation under SSF conditions presented a final cost 50-fold lower than the one obtained when culturing under SmF conditions at flask scale. In addition, the laccase production under SSF conditions in tray bioreactors reduced the final cost 4-fold compared to the one obtained under SSF conditions at flask scale, obtaining a final price of 0.04 cent €/U. Copyright © 2011 Elsevier Ltd. All rights reserved.

Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis.

PubMed

Mansfield, Haley E; Canar, W Jeffrey; Gerard, Carter S; O'Toole, John E

2014-11-01

Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs. After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery. The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status. In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF in the treatment of cervical radiculopathy.

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2014 CFR

2014-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2013 CFR

2013-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2011 CFR

2011-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2010 CFR

2010-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

20 CFR 662.270 - How are the costs of providing services through the One-Stop delivery system and the operating...

Code of Federal Regulations, 2012 CFR

2012-04-01

... through the One-Stop delivery system and the operating costs of the system to be funded? 662.270 Section... and the operating costs of the system to be funded? The MOU must describe the particular funding arrangements for services and operating costs of the One-Stop delivery system. Each partner must contribute a...

Evolution of Archival Storage (from Tape to Memory)

NASA Technical Reports Server (NTRS)

Ramapriyan, Hampapuram K.

2015-01-01

Over the last three decades, there has been a significant evolution in storage technologies supporting archival of remote sensing data. This section provides a brief survey of how these technologies have evolved. Three main technologies are considered - tape, hard disk and solid state disk. Their historical evolution is traced, summarizing how reductions in cost have helped being able to store larger volumes of data on faster media. The cost per GB of media is only one of the considerations in determining the best approach to archival storage. Active archives generally require faster response to user requests for data than permanent archives. The archive costs have to consider facilities and other capital costs, operations costs, software licenses, utilities costs, etc. For meeting requirements in any organization, typically a mix of technologies is needed.

Ultra Low-Cost Radar

NASA Astrophysics Data System (ADS)

Davies, P.; da Silva Curiel, A.; Eves, S.; Sweeting, M.; Thompson, A.; Hall, D.

From early 2003, Surrey Satellite Technology Limited (SSTL), together with its partners from Algeria, Nigeria and Turkey, has operated the Disaster Monitoring Constellation (DMC). During this period we have demonstrated the utility of a low-cost satellite system that uses optical sensors and is capable of providing daily imaging globally. For example, DMC data has been used operationally in the relief work in Darfur and following the Asian Tsunami. In addition to the use of the DMC to support disasters, the DMC has also been extensively used by the consortium members in support of national imaging needs and some residual system capacity has been provided to commercial customers. In the same timeframe, EADS Astrium Ltd has developed the technologies needed to implement the low-cost radar satellites of the MicroSAR range of synthetic aperture radar (SAR) satellites. EADS Astrium Ltd and SSTL are now looking to combine their expertises in low cost space technology and extend the capability of the DMC constellation by including a complementary small satellite radar sensor. The product of this activity is a satellite design that strikes an appropriate balance between revisit frequency and resolution. Hence, by comparison with other small satellite SAR concepts, the satellite described in this paper will provide broader area coverage at spatial resolutions in the region of 10 - 15m. Most significantly, perhaps, as a result of the specific cost targets imposed at the beginning of the design process, the satellite can provide this level of performance at a lower cost than other comparable space-based radar systems and significantly lower than larger, more performant, space-based radar systems.

Robotics and the spine: a review of current and ongoing applications.

PubMed

Shweikeh, Faris; Amadio, Jordan P; Arnell, Monica; Barnard, Zachary R; Kim, Terrence T; Johnson, J Patrick; Drazin, Doniel

2014-03-01

Robotics in the operating room has shown great use and versatility in multiple surgical fields. Robot-assisted spine surgery has gained significant favor over its relatively short existence, due to its intuitive promise of higher surgical accuracy and better outcomes with fewer complications. Here, the authors analyze the existing literature on this growing technology in the era of minimally invasive spine surgery. In an attempt to provide the most recent, up-to-date review of the current literature on robotic spine surgery, a search of the existing literature was conducted to obtain all relevant studies on robotics as it relates to its application in spine surgery and other interventions. In all, 45 articles were included in the analysis. The authors discuss the current status of this technology and its potential in multiple arenas of spinal interventions, mainly spine surgery and spine biomechanics testing. There are numerous potential advantages and limitations to robotic spine surgery, as suggested in published case reports and in retrospective and prospective studies. Randomized controlled trials are few in number and show conflicting results regarding accuracy. The present limitations may be surmountable with future technological improvements, greater surgeon experience, reduced cost, improved operating room dynamics, and more training of surgical team members. Given the promise of robotics for improvements in spine surgery and spine biomechanics testing, more studies are needed to further explore the applicability of this technology in the spinal operating room. Due to the significant cost of the robotic equipment, studies are needed to substantiate that the increased equipment costs will result in significant benefits that will justify the expense.

The role of the donor liaison officer at PlusLife (Perth Bone and Tissue Bank Inc.), Western Australia.

PubMed

Smythe, Claire; White, Nicola; Winter, Joyleen; Cowie, Anne

2015-06-01

Femoral head donation at the time of hip replacement surgery provides a much needed resource of bone allograft to orthopaedic surgeons. Prior to 2005, potential femoral head donors were identified and consented in the hospital setting on the day of surgery. This resulted in over 40 % of donations failing post operatively suggesting that more effort could be given to pre-operative screening resulting in substantial savings in the cost associated with collection and testing of donors who were subsequently failed. The Donor Liaison role was implemented in 2005 to coordinate a Femoral Head Donation program maximising the number of successful donations through pre-operative screening. This study reviews the effectiveness of pre-operative screening of potential femoral head donors at PlusLife from 2002-2012. A retrospective audit of the database was undertaken 2002-2012 and medical/social reasons for pre-operative and postoperative failures were collated into 4 main categories to enable comparison: malignancy, autoimmune conditions, variant Creutzfeldt Jakob disease risk and general medical/social reasons. The number of femoral heads failed post operatively has decreased significantly from 26 % in 2003 to 6 % in 2012. A cost of $121,000 was expended on femoral heads failed post operatively in 2004, as compared to $20,350 in 2012. Donors excluded due to the 4 main categories (medical/social history) were identified pre-operatively in over 80 % of all cases. Preoperative screening of femoral head donors through a coordinated Femoral Head Donation Program is a safe and cost effective method.

Differentiated protection method in passive optical networks based on OPEX

NASA Astrophysics Data System (ADS)

Zhang, Zhicheng; Guo, Wei; Jin, Yaohui; Sun, Weiqiang; Hu, Weisheng

2011-12-01

Reliable service delivery becomes more significant due to increased dependency on electronic services all over society and the growing importance of reliable service delivery. As the capability of PON increasing, both residential and business customers may be included in a PON. Meanwhile, OPEX have been proven to be a very important factor of the total cost for a telecommunication operator. Thus, in this paper, we present the partial protection PON architecture and compare the operational expenditures (OPEX) of fully duplicated protection and partly duplicated protection for ONUs with different distributed fiber length, reliability requirement and penalty cost per hour. At last, we propose a differentiated protection method to minimize OPEX.

Cost-effective implementation of intelligent systems

NASA Technical Reports Server (NTRS)

Lum, Henry, Jr.; Heer, Ewald

1990-01-01

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

Cost study of dermal substitutes and topical negative pressure in the surgical treatment of burns.

PubMed

Hop, M Jenda; Bloemen, Monica C T; van Baar, Margriet E; Nieuwenhuis, Marianne K; van Zuijlen, Paul P M; Polinder, Suzanne; Middelkoop, Esther

2014-05-01

A recently performed randomised controlled trial investigated the clinical effectiveness of dermal substitutes (DS) and split skin grafts (SSG) in combination with topical negative pressure (TNP) in the surgical treatment of burn wounds. In the current study, medical and non-medical costs were investigated, to comprehensively assess the benefits of this new treatment. The primary outcome was mean total costs of the four treatment strategies: SSG with or without DS, and with or without TNP. Costs were studied from a societal perspective. Findings were evaluated in light of the clinical effects on scar elasticity. Eighty-six patients were included. Twelve months post-operatively, highest elasticity was measured in scars treated with DS and TNP (p=0.027). The initial cost price of treatment with DS and TNP was €2912 compared to treatment with SSG alone €1703 (p<0.001). However, mean total costs per patient did not differ significantly between groups (range €29097-€43774). Costs of the interventional treatment contributed maximal 7% to the total costs and total costs varied widely within and between groups, but were not significantly different. Therefore, in the selection of the most optimal type of surgical intervention, cost considerations should not play an important role. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

[Cost comparison of open and robot-assisted partial nephrectomy in treatment of renal tumor].

PubMed

Abd El Fattah, V; Chevrot, A; Meusy, A; Mercier, G; Wagner, L; Soustelle, L; Boukaram, M; Thuret, R; Costa, P; Droupy, S

2016-04-01

Robot-assisted partial nephrectomy rapidly took on among urologists, even though studies showing its superiority over other techniques are still scarce and its costs hard to evaluate, especially in the French medical system. To evaluate the cost overrun of robot-assisted partial nephrectomy compared to that of open partial nephrectomy. From January 2010 to December 2013, 77 patients underwent a partial nephrectomy, 46 of which by robot-assisted laparoscopy and the remaining 31 by lombotomy. The two groups were similar in composition. Economic data regarding the staff, the consumables and the premises involved have been analyzed. Costs are significantly higher in the NPR group (9253.21 euros vs. 7448.42 euros) due to higher consumable expenses as well as the costs pertaining to the amortization and maintenance of the robot. Yet, that difference tends to diminish as the duration of the experiment increases. No significant difference was found in warm ischemia times, operation duration and renal function a month after the operation. On the other hand, patients from the NPR group spent a significantly smaller amount of time in recovery room (159 minutes vs. 205 minutes, P=0.004), presented fewer complications and were discharged faster (6.1 days vs. 8.1 days, P=0.04). To be profitable for the hospital in the French GHS system, robot-assisted partial nephrectomy must take place in a complex where at least 300 robot-assisted interventions are performed annually, in the framework of a hospitalization lasting four days or less, the use of a single needle holder and no systematic use of a haemostatic agent. 4. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

75 FR 37883 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-30

... Planning and Cost Allocation by Transmission Owning and Operating Public Utilities; Proposed Rule #0;#0...] Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities Issued June 17... Transmission Services by Public Utilities; Recovery of Stranded Costs by Public Utilities and Transmitting...

[12th Annual] Maintenance & Operations Cost Study.

ERIC Educational Resources Information Center

Deriso, Jerald L.; Lane, C. Jerome

1983-01-01

Comparisons are shown between budgeted maintenance and operations costs for 1982-83 and the preceding two years' actual costs. Also provided is a summary of a 10-year comparison of net current expenditures per student, compared with maintenance and operations costs per student. Data are presented for 10 geographical regions. (MLF)

13th Annual Maintenance & Operations Cost Study.

ERIC Educational Resources Information Center

Deriso, Jerald L.

1984-01-01

Comparisons are drawn between budgeted maintenance and operations costs for 1983-84 and the preceding 2 years' actual costs. Also provided is a summary of a 10-year comparison of net current expenditures per student, compared with maintenance and operations costs per student. Data are presented for 10 geographical regions. (MLF)

Overview of escalator applications in rail transit

NASA Technical Reports Server (NTRS)

Deshpande, G.; Rubenstein, L.

1980-01-01

The difference in operating environment and in construction between escalators in transit and nontransit use, the impact of recent escalator innovations, and areas which could benefit from urban mass transportation administration sponsored research and development are determined. Several factors causing a more severe transit escalator operating environment are identified. There are no significant design differences between transit and nontransit escalators. Recent innovations that have affected performance and cost include outdoor escalators, extra flat steps at both landings, and modular escalators. Data were collected by interviews at transit agencies. Long term, unscheduled, escalator maintenance records were available for analysis from one property. A description of escalator operating principles is provided. Transit represents less than 5% of the U.S. escalator market. Transit agencies have limited leverage on escalator industry practices. A substantial impact on transit escalator cost and performance can be achieved by research identifying when and how to apply and specify several of the more recent innovations. Purchase of escalators under long term (25 year) maintenance contracts is one method that has been used to promote escalators manufactured for minimum life cycle cost.

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

PubMed

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

2018-06-08

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

Effects of intra-operative fluoroscopic 3D-imaging on peri-operative imaging strategy in calcaneal fracture surgery.

PubMed

Beerekamp, M S H; Backes, M; Schep, N W L; Ubbink, D T; Luitse, J S; Schepers, T; Goslings, J C

2017-12-01

Previous studies demonstrated that intra-operative fluoroscopic 3D-imaging (3D-imaging) in calcaneal fracture surgery is promising to prevent revision surgery and save costs. However, these studies limited their focus to corrections performed after 3D-imaging, thereby neglecting corrections after intra-operative fluoroscopic 2D-imaging (2D-imaging). The aim of this study was to assess the effects of additional 3D-imaging on intra-operative corrections, peri-operative imaging used, and patient-relevant outcomes compared to 2D-imaging alone. In this before-after study, data of adult patients who underwent open reduction and internal fixation (ORIF) of a calcaneal fracture between 2000 and 2014 in our level-I Trauma center were collected. 3D-imaging (BV Pulsera with 3D-RX, Philips Healthcare, Best, The Netherlands) was available as of 2007 at the surgeons' discretion. Patient and fracture characteristics, peri-operative imaging, intra-operative corrections and patient-relevant outcomes were collected from the hospital databases. Patients in whom additional 3D-imaging was applied were compared to those undergoing 2D-imaging alone. A total of 231 patients were included of whom 107 (46%) were operated with the use of 3D-imaging. No significant differences were found in baseline characteristics. The median duration of surgery was significantly longer when using 3D-imaging (2:08 vs. 1:54 h; p = 0.002). Corrections after additional 3D-imaging were performed in 53% of the patients. However, significantly fewer corrections were made after 2D-imaging when 3D-imaging was available (Risk difference (RD) -15%; 95% Confidence interval (CI) -29 to -2). Peri-operative imaging, besides intra-operative 3D-imaging, and patient-relevant outcomes were similar between groups. Intra-operative 3D-imaging provides additional information resulting in additional corrections. Moreover, 3D-imaging probably changed the surgeons' attitude to rely more on 3D-imaging, hence a 15%-decrease of corrections performed after 2D-imaging when 3D imaging was available. No substantiation for cost reduction was found through reduction in peri-operative imaging or in terms of improved patient-relevant outcomes.

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers.

PubMed

Roy, Sanjoy; Yoo, Andrew; Yadalam, Sashi; Fegelman, Elliott J; Kalsekar, Iftekhar; Johnston, Stephen S

2017-04-01

To compare economic and clinical outcomes between patients undergoing laparoscopic Roux-en-Y gastric bypass (LRY) or laparoscopic sleeve gastrectomy (LSG) with use of powered vs manual endoscopic surgical staplers. Patients (aged ≥21 years) who underwent LRY or LSG during a hospital admission (January 1, 2012-September 30, 2015) were identified from the Premier Perspective Hospital Database. Use of powered vs manual staplers was identified from hospital administrative billing records. Multivariable analyses were used to compare the following outcomes between the powered and manual stapler groups, adjusting for patient and hospital characteristics and hospital-level clustering: hospital length of stay (LOS), total hospital costs, medical/surgical supply costs, room and board costs, operating room costs, operating room time, discharge status, bleeding/transfusion during the hospital admission, and 30, 60, and 90-day all-cause readmissions. The powered and manual stapler groups comprised 9,851 patients (mean age = 44.6 years; 79.3% female) and 21,558 patients (mean age = 45.0 years; 78.0% female), respectively. In the multivariable analyses, adjusted mean hospital LOS was 2.1 days for both the powered and manual stapler groups (p = .981). Adjusted mean total hospital costs ($12,415 vs $13,547, p = .003), adjusted mean supply costs ($4,629 vs $5,217, p = .011), and adjusted mean operating room costs ($4,126 vs $4,413, p = .009) were significantly lower in the powered vs manual stapler group. The adjusted rate of bleeding and/or transfusion during the hospital admission (2.46% vs 3.22%, p = .025) was significantly lower in the powered vs manual stapler group. The adjusted rates of 30, 60, and 90-day all-cause readmissions were similar between the groups (all p > .05). Sub-analysis by manufacturer showed similar results. This observational study cannot establish causal linkages. In this analysis of patients who underwent LRY or LSG, the use of powered staplers was associated with better economic outcomes, and a lower rate of bleeding/transfusion vs manual staplers in the real-world setting.

On Operating a Nanofiltration Membrane for Olive Mill Wastewater Purification at Sub- and Super-Boundary Conditions.

PubMed

Stoller, Marco; Ochando-Pulido, Javier Miguel; Field, Robert

2017-07-14

In the last decades, membrane processes have gained a significant share of the market for wastewater purification. Although the product (i.e., purified water) is not of high added value, these processes are feasible both technically and from an economic point of view, provided the flux is relatively high and that membrane fouling is strongly inhibited. By controlling membrane fouling, the membrane may work for years without service, thus dramatically reducing operating costs and the need for membrane substitution. There is tension between operating at high permeate fluxes, which enhances fouling but reduces capital costs, and operating at lower fluxes which increases capital costs. Operating batch membrane processes leads to increased difficulties, since the feed fed to the membrane changes as a function of the recovery value. This paper is concerned with the operation of such a process. Membrane process designers should therefore avoid membrane fouling by operating membranes away from the permeate flux point where severe fouling is triggered. The design and operation of membrane purification plants is a difficult task, and the precision to properly describe the evolution of the fouling phenomenon as a function of the operating conditions is a key to success. Many reported works have reported on the control of fouling by operating below the boundary flux. On the other hand, only a few works have successfully sought to exploit super-boundary operating conditions; most super-boundary operations are reported to have led to process failures. In this work, both sub- and super-boundary operating conditions for a batch nanofiltration membrane process used for olive mill wastewater treatment were investigated. A model to identify a priori the point of transition from a sub-boundary to a super-boundary operation during a batch operation was developed, and this will provide membrane designers with a helpful tool to carefully avoid process failures.

The Launch Systems Operations Cost Model

NASA Technical Reports Server (NTRS)

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

2001-01-01

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

RFID Technology for Continuous Monitoring of Physiological Signals in Small Animals.

PubMed

Volk, Tobias; Gorbey, Stefan; Bhattacharyya, Mayukh; Gruenwald, Waldemar; Lemmer, Björn; Reindl, Leonhard M; Stieglitz, Thomas; Jansen, Dirk

2015-02-01

Telemetry systems enable researchers to continuously monitor physiological signals in unrestrained, freely moving small rodents. Drawbacks of common systems are limited operation time, the need to house the animals separately, and the necessity of a stable communication link. Furthermore, the costs of the typically proprietary telemetry systems reduce the acceptance. The aim of this paper is to introduce a low-cost telemetry system based on common radio frequency identification technology optimized for battery-independent operational time, good reusability, and flexibility. The presented implant is equipped with sensors to measure electrocardiogram, arterial blood pressure, and body temperature. The biological signals are transmitted as digital data streams. The device is able of monitoring several freely moving animals housed in groups with a single reader station. The modular concept of the system significantly reduces the costs to monitor multiple physiological functions and refining procedures in preclinical research.

Integrating O/S models during conceptual design, part 1

NASA Technical Reports Server (NTRS)

Ebeling, Charles E.

1994-01-01

The University of Dayton is pleased to submit this report to the National Aeronautics and Space Administration (NASA), Langley Research Center, which integrates a set of models for determining operational capabilities and support requirements during the conceptual design of proposed space systems. This research provides for the integration of the reliability and maintainability (R&M) model, both new and existing simulation models, and existing operations and support (O&S) costing equations in arriving at a complete analysis methodology. Details concerning the R&M model and the O&S costing model may be found in previous reports accomplished under this grant (NASA Research Grant NAG1-1327). In the process of developing this comprehensive analysis approach, significant enhancements were made to the R&M model, updates to the O&S costing model were accomplished, and a new simulation model developed. This is the 1st part of a 3 part technical report.

Putting a price tag on novel autologous cellular therapies.

PubMed

Abou-El-Enein, Mohamed; Bauer, Gerhard; Medcalf, Nicholas; Volk, Hans-Dieter; Reinke, Petra

2016-08-01

Cell therapies, especially autologous therapies, pose significant challenges to researchers who wish to move from small, probably academic, methods of manufacture to full commercial scale. There is a dearth of reliable information about the costs of operation, and this makes it difficult to predict with confidence the investment needed to translate the innovations to the clinic, other than as small-scale, clinician-led prescriptions. Here, we provide an example of the results of a cost model that takes into account the fixed and variable costs of manufacture of one such therapy. We also highlight the different factors that influence the product final pricing strategy. Our findings illustrate the need for cooperative and collective action by the research community in pre-competitive research to generate the operational models that are much needed to increase confidence in process development for these advanced products. Copyright © 2016 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Impact of Advanced Propeller Technology on Aircraft/Mission Characteristics of Several General Aviation Aircraft

NASA Technical Reports Server (NTRS)

Keiter, I. D.

1982-01-01

Studies of several General Aviation aircraft indicated that the application of advanced technologies to General Aviation propellers can reduce fuel consumption in future aircraft by a significant amount. Propeller blade weight reductions achieved through the use of composites, propeller efficiency and noise improvements achieved through the use of advanced concepts and improved propeller analytical design methods result in aircraft with lower operating cost, acquisition cost and gross weight.

Atmosphere to Electrons (A2e): Enabling the Wind Plant of Tomorrow

ScienceCinema

Zayas, Jose; Derby, Mike; Ralston, Kiersten; Clark, Charlton; Brake, Dan; Johnson, Nick

2018-01-16

Atmosphere to Electrons (A2e) is a multi-year U.S. Department of Energy (DOE) research initiative targeting significant reductions in the cost of wind energy through an improved understanding of the complex physics governing electricity generation by wind plants. The goal of A2e is to ensure future wind plants are sited, built, and operated in a way that produces the most cost-effective, usable electric power.

Structure of public transit costs in the presence of multiple serial correlation

DOT National Transportation Integrated Search

1999-12-01

Most studies indicate that public transit systems operate under increasing returns to capital stock utilization and are significantly overcapitalized. Existing flexible form time series analyses, however, fail to correct for serial correlation. In th...

On the Need for Artificial Intelligence and Advanced Test and Evaluation Methods for Space Exploration

NASA Astrophysics Data System (ADS)

Scheidt, D. H.; Hibbitts, C. A.; Chen, M. H.; Paxton, L. J.; Bekker, D. L.

2017-02-01

Implementing mature artificial intelligence would create the ability to significantly increase the science return from a mission, while potentially saving costs in mission and instrument operations, and solving currently intractable problems.

Preventive maintenance criteria : final project report.

DOT National Transportation Integrated Search

2016-08-15

The North Carolina Department of Transportation operates a large and varied fleet of on-road and off-road equipment. Regular oil changes for these machines result in significant costs due to the required labor, replacement oil and filters, and dispos...

Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings

PubMed Central

Keus, Frederik; de Jonge, Trudy; Gooszen, Hein G; Buskens, Erik; van Laarhoven, Cornelis JHM

2009-01-01

Background After its introduction, laparoscopic cholecystectomy rapidly expanded around the world and was accepted the procedure of choice by consensus. However, analysis of evidence shows no difference regarding primary outcome measures between laparoscopic and small-incision cholecystectomy. In absence of clear clinical benefit it may be interesting to focus on the resource use associated with the available techniques, a secondary outcome measure. This study focuses on a difference in costs between laparoscopic and small-incision cholecystectomy from a societal perspective with emphasis on internal validity and generalisability Methods A blinded randomized single-centre trial was conducted in a general teaching hospital in The Netherlands. Patients with reasonable to good health diagnosed with symptomatic cholecystolithiasis scheduled for cholecystectomy were included. Patients were randomized between laparoscopic and small-incision cholecystectomy. Total costs were analyzed from a societal perspective. Results Operative costs were higher in the laparoscopic group using reusable laparoscopic instruments (difference 203 euro; 95% confidence interval 147 to 259 euro). There were no significant differences in the other direct cost categories (outpatient clinic and admittance related costs), indirect costs, and total costs. More than 60% of costs in employed patients were caused by sick leave. Conclusion Based on differences in costs, small-incision cholecystectomy seems to be the preferred operative technique over the laparoscopic technique both from a hospital and societal cost perspective. Sick leave associated with convalescence after cholecystectomy in employed patients results in considerable costs to society. Trial registration ISRCTN Register, number ISRCTN67485658. PMID:19732431

An economic model to evaluate cost-effectiveness of computer assisted knee replacement surgery in Norway.

PubMed

Gøthesen, Øystein; Slover, James; Havelin, Leif; Askildsen, Jan Erik; Malchau, Henrik; Furnes, Ove

2013-07-06

The use of Computer Assisted Surgery (CAS) for knee replacements is intended to improve the alignment of knee prostheses in order to reduce the number of revision operations. Is the cost effectiveness of computer assisted surgery influenced by patient volume and age? By employing a Markov model, we analysed the cost effectiveness of computer assisted surgery versus conventional arthroplasty with respect to implant survival and operation volume in two theoretical Norwegian age cohorts. We obtained mortality and hospital cost data over a 20-year period from Norwegian registers. We presumed that the cost of an intervention would need to be below NOK 500,000 per QALY (Quality Adjusted Life Year) gained, to be considered cost effective. The added cost of computer assisted surgery, provided this has no impact on implant survival, is NOK 1037 and NOK 1414 respectively for 60 and 75-year-olds per quality-adjusted life year at a volume of 25 prostheses per year, and NOK 128 and NOK 175 respectively at a volume of 250 prostheses per year. Sensitivity analyses showed that the 10-year implant survival in cohort 1 needs to rise from 89.8% to 90.6% at 25 prostheses per year, and from 89.8 to 89.9% at 250 prostheses per year for computer assisted surgery to be considered cost effective. In cohort 2, the required improvement is a rise from 95.1% to 95.4% at 25 prostheses per year, and from 95.10% to 95.14% at 250 prostheses per year. The cost of using computer navigation for total knee replacements may be acceptable for 60-year-old as well as 75-year-old patients if the technique increases the implant survival rate just marginally, and the department has a high operation volume. A low volume department might not achieve cost-effectiveness unless computer navigation has a more significant impact on implant survival, thus may defer the investments until such data are available.

Cost Experience of Automated Guideway Transit Systems. (Supplement V) Costs and Trends for the Period 1976-1982.

DOT National Transportation Integrated Search

1984-04-01

This report summarizes the cost experiences and trends of sixteen domestic AGT systems. Capital costs, operation and maintenance costs, system characteristics, operational statistics, and unit cost measures are presented to provide useful information...

Spacelab Mission Implementation Cost Assessment (SMICA)

NASA Technical Reports Server (NTRS)

Guynes, B. V.

1984-01-01

A total savings of approximately 20 percent is attainable if: (1) mission management and ground processing schedules are compressed; (2) the equipping, staffing, and operating of the Payload Operations Control Center is revised, and (3) methods of working with experiment developers are changed. The development of a new mission implementation technique, which includes mission definition, experiment development, and mission integration/operations, is examined. The Payload Operations Control Center is to relocate and utilize new computer equipment to produce cost savings. Methods of reducing costs by minimizing the Spacelab and payload processing time during pre- and post-mission operation at KSC are analyzed. The changes required to reduce costs in the analytical integration process are studied. The influence of time, requirements accountability, and risk on costs is discussed. Recommendation for cost reductions developed by the Spacelab Mission Implementation Cost Assessment study are listed.

Wind Plant Performance Prediction (WP3) Project

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

Craig, Anna

The methods for analysis of operational wind plant data are highly variable across the wind industry, leading to high uncertainties in the validation and bias-correction of preconstruction energy estimation methods. Lack of credibility in the preconstruction energy estimates leads to significant impacts on project financing and therefore the final levelized cost of energy for the plant. In this work, the variation in the evaluation of a wind plant's operational energy production as a result of variations in the processing methods applied to the operational data is examined. Preliminary results indicate that selection of the filters applied to the data andmore » the filter parameters can have significant impacts in the final computed assessment metrics.« less

A Field Investigation and Facility Review of Eight Modular Starved-Air Heat Recovery Incinerator Systems.

DTIC Science & Technology

1984-10-01

are shared with the production facility. I Capital Costs: $260,000 (1976) plus $45,000 for the building. Operating and Maintenance Costs: O&M costs are...agricultural product processing plant. Operation: Three shifts, 5.5 days/week, 52 weeks/year. Capital Costs: Total capital cost S1,400,000 (1981...which makes their operating and maintenance costs, waste tonnages, ; and steam production readily available. Sample Data (All Numbers Rounded) 1st

Cost-performance analysis of nutrient removal in a full-scale oxidation ditch process based on kinetic modeling.

PubMed

Li, Zheng; Qi, Rong; Wang, Bo; Zou, Zhe; Wei, Guohong; Yang, Min

2013-01-01

A full-scale oxidation ditch process for treating sewage was simulated with the ASM2d model and optimized for minimal cost with acceptable performance in terms of ammonium and phosphorus removal. A unified index was introduced by integrating operational costs (aeration energy and sludge production) with effluent violations for performance evaluation. Scenario analysis showed that, in comparison with the baseline (all of the 9 aerators activated), the strategy of activating 5 aerators could save aeration energy significantly with an ammonium violation below 10%. Sludge discharge scenario analysis showed that a sludge discharge flow of 250-300 m3/day (solid retention time (SRT), 13-15 days) was appropriate for the enhancement of phosphorus removal without excessive sludge production. The proposed optimal control strategy was: activating 5 rotating disks operated with a mode of "111100100" ("1" represents activation and "0" represents inactivation) for aeration and sludge discharge flow of 200 m3/day (SRT, 19 days). Compared with the baseline, this strategy could achieve ammonium violation below 10% and TP violation below 30% with substantial reduction of aeration energy cost (46%) and minimal increment of sludge production (< 2%). This study provides a useful approach for the optimization of process operation and control.

Minimizing the health and climate impacts of emissions from heavy-duty public transportation bus fleets through operational optimization.

PubMed

Gouge, Brian; Dowlatabadi, Hadi; Ries, Francis J

2013-04-16

In contrast to capital control strategies (i.e., investments in new technology), the potential of operational control strategies (e.g., vehicle scheduling optimization) to reduce the health and climate impacts of the emissions from public transportation bus fleets has not been widely considered. This case study demonstrates that heterogeneity in the emission levels of different bus technologies and the exposure potential of bus routes can be exploited though optimization (e.g., how vehicles are assigned to routes) to minimize these impacts as well as operating costs. The magnitude of the benefits of the optimization depend on the specific transit system and region. Health impacts were found to be particularly sensitive to different vehicle assignments and ranged from worst to best case assignment by more than a factor of 2, suggesting there is significant potential to reduce health impacts. Trade-offs between climate, health, and cost objectives were also found. Transit agencies that do not consider these objectives in an integrated framework and, for example, optimize for costs and/or climate impacts alone, risk inadvertently increasing health impacts by as much as 49%. Cost-benefit analysis was used to evaluate trade-offs between objectives, but large uncertainties make identifying an optimal solution challenging.

Economic case for the retirement of geosynchronous communication satellites via space tugs

NASA Astrophysics Data System (ADS)

Galabova, Kalina K.; de Weck, Olivier L.

2006-05-01

Both the United Nations (UN) and the US Federal Communications Commission (FCC) have published a ruling that calls for geostationary earth orbit (GEO) satellites to be placed in a disposal orbit at the end of their operational lives. Current procedures utilize spacecraft residual propellant and represent a major life-limiting factor for GEO satellites. An alternative approach would be to allow a space tug to capture and move the satellites after all of their fuel has been exhausted. This extended lifetime can provide significant additional revenue to some satellite operators. Before committing to such a capability, however, the lifecycle costs of a space tug infrastructure must be carefully weighed against the opportunity costs of the current retirement practice. This paper investigates the questions of tug costs, perceived benefits, and service fee. It builds a framework that can be used in evaluating various on-orbit servicing opportunities and proposes that the service fee should be charged as a percentage of the additional revenue received by the satellite operators and analyzes how cost estimation uncertainties affect the value of on-orbit tugging. The presented analysis concludes that until advanced propulsion systems gain greater use, retirement via a space tug will be of value for the 10-20 most expensive GEO assets.

Method for Household Refrigerators Efficiency Increasing

NASA Astrophysics Data System (ADS)

Lebedev, V. V.; Sumzina, L. V.; Maksimov, A. V.

2017-11-01

The relevance of working processes parameters optimization in air conditioning systems is proved in the work. The research is performed with the use of the simulation modeling method. The parameters optimization criteria are considered, the analysis of target functions is given while the key factors of technical and economic optimization are considered in the article. The search for the optimal solution at multi-purpose optimization of the system is made by finding out the minimum of the dual-target vector created by the Pareto method of linear and weight compromises from target functions of the total capital costs and total operating costs. The tasks are solved in the MathCAD environment. The research results show that the values of technical and economic parameters of air conditioning systems in the areas relating to the optimum solutions’ areas manifest considerable deviations from the minimum values. At the same time, the tendencies for significant growth in deviations take place at removal of technical parameters from the optimal values of both the capital investments and operating costs. The production and operation of conditioners with the parameters which are considerably deviating from the optimal values will lead to the increase of material and power costs. The research allows one to establish the borders of the area of the optimal values for technical and economic parameters at air conditioning systems’ design.

Optimizing Air Transportation Service to Metroplex Airports. Part 1; Analysis of Historical Data

NASA Technical Reports Server (NTRS)

Donohue, George; Hoffman, Karla; Sherry, Lance; Ferguson, John; Kara, Abdul Qadar

2010-01-01

The air transportation system is a significant driver of the U.S. economy, providing safe, affordable, and rapid transportation. During the past three decades airspace and airport capacity has not grown in step with demand for air transportation (+4% annual growth), resulting in unreliable service and systemic delays. Estimates of the impact of delays and unreliable air transportation service on the economy range from $32B to $41B per year. This report describes the results of an analysis of airline strategic decision-making with regards to: (1) geographic access, (2) economic access, and (3) airline finances. This analysis evaluated markets-served, scheduled flights, aircraft size, airfares, and profit from 2005-2009. During this period, airlines experienced changes in costs of operation (due to fluctuations in hedged fuel prices), changes in travel demand (due to changes in the economy), and changes in infrastructure capacity (due to the capacity limits at EWR, JFK, and LGA). This analysis captures the impact of the implementation of capacity limits at airports, as well as the effect of increased costs of operation (i.e. hedged fuel prices). The increases in costs of operation serve as a proxy for increased costs per flight that might occur if auctions or congestion pricing are imposed.

Operations Analysis of the 2nd Generation Reusable Launch Vehicle

NASA Technical Reports Server (NTRS)

Noneman, Steven R.; Smith, C. A. (Technical Monitor)

2002-01-01

The Space Launch Initiative (SLI) program is developing a second-generation reusable launch vehicle. The program goals include lowering the risk of loss of crew to 1 in 10,000 and reducing annual operations cost to one third of the cost of the Space Shuttle. The SLI missions include NASA, military and commercial satellite launches and crew and cargo launches to the space station. The SLI operations analyses provide an assessment of the operational support and infrastructure needed to operate candidate system architectures. Measures of the operability are estimated (i.e. system dependability, responsiveness, and efficiency). Operations analysis is used to determine the impact of specific technologies on operations. A conceptual path to reducing annual operations costs by two thirds is based on key design characteristics, such as reusability, and improved processes lowering labor costs. New operations risks can be expected to emerge. They can be mitigated with effective risk management with careful identification, assignment, tracking, and closure. SLI design characteristics such as nearly full reusability, high reliability, advanced automation, and lowered maintenance and servicing coupled with improved processes are contributors to operability and large operating cost reductions.

[Descriptive analysis of work and trends in anaesthesiology from 2005 to 2006: quantitative and qualitative aspects of effects and evaluation of anaesthesia].

PubMed

Majstorović, Branislava M; Simić, Snezana; Milaković, Branko D; Vucović, Dragan S; Aleksić, Valentina V

2010-01-01

In anaesthesiology, economic aspects have been insufficiently studied. The aim of this paper was the assessment of rational choice of the anaesthesiological services based on the analysis of the scope, distribution, trend and cost. The costs of anaesthesiological services were counted based on "unit" prices from the Republic Health Insurance Fund. Data were analysed by methods of descriptive statistics and statistical significance was tested by Student's t-test and chi2-test. The number of general anaesthesia was higher and average time of general anaesthesia was shorter, without statistical significance (t-test, p = 0.436) during 2006 compared to the previous year. Local anaesthesia was significantly higher (chi2-test, p = 0.001) in relation to planned operation in emergency surgery. The analysis of total anaesthesiological procedures revealed that a number of procedures significantly increased in ENT and MFH surgery, and ophthalmology, while some reduction was observed in general surgery, orthopaedics and trauma surgery and cardiovascular surgery (chi2-test, p = 0.000). The number of analgesia was higher than other procedures (chi2-test, p = 0.000). The structure of the cost was 24% in neurosurgery, 16% in digestive (general) surgery,14% in gynaecology and obstetrics, 13% in cardiovascular surgery and 9% in emergency room. Anaesthesiological services costs were the highest in neurosurgery, due to the length anaesthesia, and digestive surgery due to the total number of general anaesthesia performed. It is important to implement pharmacoeconomic studies in all departments, and to separate the anaesthesia services for emergency and planned operations. Disproportions between the number of anaesthesia, surgery interventions and the number of patients in surgical departments gives reason to design relation database.

Single anterior portal: A better option for arthroscopic treatment of traumatic anterior shoulder instability?

PubMed

Çiçek, Hakan; Tuhanioğlu, Ümit; Oğur, Hasan Ulaş; Seyfettinoğlu, Fırat; Çiloğlu, Osman; Beyzadeoğlu, Tahsin

2017-07-01

The aim of this study was to compare single and double anterior portal techniques in the arthroscopic treatment of traumatic anterior shoulder instability. A total of 91 cases who underwent arthroscopic Bankart repair for anterior shoulder instability were reviewed. The patients were divided into 2 groups as Group 1 (47 male and 2 female; mean age: 25.8 ± 6.8) for arthroscopic single anterior portal approach and Group 2 (41 male and 1 female; mean age: 25.4 ± 6.6) for the classical anterior double portal approach. The groups were compared for clinical scores, range of motion, analgesia requirement, complications, duration of surgery, cost and learning curve according to a short questionnaire completed by the relevant healthcare professionals. No statistically significant difference was found between the 2 groups in terms of pre-operative and post-operative Constant and Rowe Shoulder Scores, range of motion and complications (p > 0.05). In Group 2 patients, the requirement for post-operative analgesics was significantly higher (p < 0.001), whereas the duration of surgery was statistically significantly shorter in Group 1 (p < 0.001). In the assessment of the questionnaire, it was seen that a single portal anterior approach was preferred at a higher ratio (p = 0.035). The cost analysis revealed that the cost was 5.7% less for patients with a single portal. In the arthroscopic treatment of traumatic anterior shoulder instability accompanied by a Bankart lesion, the anterior single portal technique is as successful in terms of clinical results as the conventional double portal approach. The single portal technique has advantages such as less postoperative pain, a shorter surgical learning curve and lower costs. Level III, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Displaying contextual information reduces the costs of imperfect decision automation in rapid retasking of ISR assets.

PubMed

Rovira, Ericka; Cross, Austin; Leitch, Evan; Bonaceto, Craig

2014-09-01

The impact of a decision support tool designed to embed contextual mission factors was investigated. Contextual information may enable operators to infer the appropriateness of data underlying the automation's algorithm. Research has shown the costs of imperfect automation are more detrimental than perfectly reliable automation when operators are provided with decision support tools. Operators may trust and rely on the automation more appropriately if they understand the automation's algorithm. The need to develop decision support tools that are understandable to the operator provides the rationale for the current experiment. A total of 17 participants performed a simulated rapid retasking of intelligence, surveillance, and reconnaissance (ISR) assets task with manual, decision automation, or contextual decision automation differing in two levels of task demand: low or high. Automation reliability was set at 80%, resulting in participants experiencing a mixture of reliable and automation failure trials. Dependent variables included ISR coverage and response time of replanning routes. Reliable automation significantly improved ISR coverage when compared with manual performance. Although performance suffered under imperfect automation, contextual decision automation helped to reduce some of the decrements in performance. Contextual information helps overcome the costs of imperfect decision automation. Designers may mitigate some of the performance decrements experienced with imperfect automation by providing operators with interfaces that display contextual information, that is, the state of factors that affect the reliability of the automation's recommendation.

Operating Room Delays: Meaningful Use in Electronic Health Record.

PubMed

Van Winkle, Rachelle A; Champagne, Mary T; Gilman-Mays, Meri; Aucoin, Julia

2016-06-01

Perioperative areas are the most costly to operate and account for more than 40% of expenses. The high costs prompted one organization to analyze surgical delays through a retrospective review of their new electronic health record. Electronic health records have made it easier to access and aggregate clinical data; 2123 operating room cases were analyzed. Implementing a new electronic health record system is complex; inaccurate data and poor implementation can introduce new problems. Validating the electronic health record development processes determines the ease of use and the user interface, specifically related to user compliance with the intent of the electronic health record development. The revalidation process after implementation determines if the intent of the design was fulfilled and data can be meaningfully used. In this organization, the data fields completed through automation provided quantifiable, meaningful data. However, data fields completed by staff that required subjective decision making resulted in incomplete data nearly 24% of the time. The ease of use was further complicated by 490 permutations (combinations of delay types and reasons) that were built into the electronic health record. Operating room delay themes emerged notwithstanding the significant complexity of the electronic health record build; however, improved accuracy could improve meaningful data collection and a more accurate root cause analysis of operating room delays. Accurate and meaningful use of data affords a more reliable approach in quality, safety, and cost-effective initiatives.

Large horizontal axis wind turbine development

NASA Technical Reports Server (NTRS)

Robbins, W. H.; Thomas, R. L.

1979-01-01

An overview of the NASA activities concerning ongoing wind systems oriented toward utility application is presented. First-generation-technology large wind turbines were designed and are in operation at selected utility sites. In order to make a significant energy impact, costs of 2 to 3 cents per kilowatt hour must be achieved. The federal program continues to fund the development by industry of wind turbines which can meet the cost goals of 2 to 3 cents per kilowatt hour. Lower costs are achieved through the incorporation of new technology and innovative system design to reduce weight and increase energy capture.

Cost of Unsuitability: Assessment of Trade-offs Between the Cost of Operational Unsuitability and Research, Development, Test and Evaluation (RDT&E) Costs

DTIC Science & Technology

2008-03-01

July 2004 and OT- IIG from March–June 2005. Only phase OT- IIG was used as the basis for its suitability evaluation, however, as the test aircraft...received several significant “Block B” hardware and software upgrades in March 2005. At OT- IIG the MV-22 met all of the JORD’s R&M requirements save...mean repair time for aborts. B. MEAN FLIGHT HOURS BETWEEN FAILURES—LOGISTICS The DOT&E report following OT- IIG states that the two key measures of

75 FR 7411 - Schedule of Water Charges

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-19

... sale revenues, while the costs of reservoir maintenance and operations, contractual services and..., ``including debt service, operation, maintenance, replacement, reserves, and associated administrative costs... holds funds dedicated to pay the costs of project construction, operation, maintenance, and replacement...

Resident education in robotic-assisted vertical sleeve gastrectomy: outcomes and cost-analysis of 411 consecutive cases.

PubMed

Ecker, Brett L; Maduka, Richard; Ramdon, Andre; Dempsey, Daniel T; Dumon, Kristoffel R; Williams, Noel N

2016-02-01

Robotic technology is increasingly prevalent in bariatric surgery, yet there are national deficiencies in exposure of surgical residents to robotic techniques. The purpose of this study is to accurately characterize the perioperative outcomes of a resident teaching model using the robotic-assisted sleeve gastrectomy. University Hospital. We identified 411 consecutive patients who underwent robotic sleeve gastrectomy at our institution from a prospectively maintained administrative database. Perioperative morbidity, operative time, and supply cost of the procedure were analyzed. Mean operative time was 96.4±24.9 minutes; mean robot usage time was 63.9 minutes (range 30.0-122.0 min). Ninety-day morbidities included reoperation (0.72%), major bleeding complications (0.48%), staple line leak (0.24%), stricture (0.97%), need for blood transfusion (3.86%), surgical site infection (1.69%), deep vein thrombosis (0.48%), and pulmonary embolism (0.48%). Mortality was nil. The resident cohort achieved operative time plateaus after five consecutive cases. Subset analysis for fiscal year 2014 demonstrated significantly increased supply cost for robotic sleeve gastrectomy compared with its laparoscopic equivalent. Robotic-assisted sleeve gastrectomy can be instituted as a model for resident robotic education with rates of morbidity and operative times equivalent to historical laparoscopic controls. The robot's enhanced ergonomics and its opportunity for resident education must be weighed against its increased supply cost. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

The Impact of Information Technology on the Design, Development, and Implementation of a Lunar Exploration Mission

NASA Technical Reports Server (NTRS)

Gross, Anthony R.; Sims, Michael H.; Briggs, Geoffrey A.

1996-01-01

From the beginning to the present expeditions to the Moon have involved a large investment of human labor. This has been true for all aspects of the process, from the initial design of the mission, whether scientific or technological, through the development of the instruments and the spacecraft, to the flight and operational phases. In addition to the time constraints that this situation imposes, there is also a significant cost associated with the large labor costs. As a result lunar expeditions have been limited to a few robotic missions and the manned Apollo program missions of the 1970s. With the rapid rise of the new information technologies, new paradigms are emerging that promise to greatly reduce both the time and cost of such missions. With the rapidly increasing capabilities of computer hardware and software systems, as well as networks and communication systems, a new balance of work is being developed between the human and the machine system. This new balance holds the promise of greatly increased exploration capability, along with dramatically reduced design, development, and operating costs. These new information technologies, utilizing knowledge-based software and very highspeed computer systems, will provide new design and development tools, scheduling mechanisms, and vehicle and system health monitoring capabilities that have hitherto been unavailable to the mission and spacecraft designer and the system operator. This paper will utilize typical lunar missions, both robotic and crewed, as a basis to describe and illustrate how these new information system technologies could be applied to all aspects such missions. In particular, new system design tradeoff tools will be described along with technologies that will allow a very much greater degree of autonomy of exploration vehicles than has heretofore been possible. In addition, new information technologies that will significantly reduce the human operational requirements will be discussed.

Whole Building Cost and Performance Measurement: Data Collection Protocol Revision 2

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

Fowler, Kimberly M.; Spees, Kathleen L.; Kora, Angela R.

2009-03-27

This protocol was written for the Department of Energy’s Federal Energy Management Program (FEMP) to be used by the public as a tool for assessing building cost and performance measurement. The primary audiences are sustainable design professionals, asset owners, building managers, and research professionals within the Federal sector. The protocol was developed based on the need for measured performance and cost data on sustainable design projects. Historically there has not been a significant driver in the public or private sector to quantify whole building performance in comparable terms. The deployment of sustainable design into the building sector has initiated manymore » questions on the performance and operational cost of these buildings.« less

Space Operations Center orbit altitude selection strategy

NASA Technical Reports Server (NTRS)

Indrikis, J.; Myers, H. L.

1982-01-01

The strategy for the operational altitude selection has to respond to the Space Operation Center's (SOC) maintenance requirements and the logistics demands of the missions to be supported by the SOC. Three orbit strategies are developed: two are constant altitude, and one variable altitude. In order to minimize the effect of atmospheric uncertainty the dynamic altitude method is recommended. In this approach the SOC will operate at the optimum altitude for the prevailing atmospheric conditions and logistics model, provided that mission safety constraints are not violated. Over a typical solar activity cycle this method produces significant savings in the overall logistics cost.

Linking and Combining Distributed Operations Facilities using NASA's "GMSEC" Systems Architectures

NASA Technical Reports Server (NTRS)

Smith, Danford; Grubb, Thomas; Esper, Jaime

2008-01-01

NASA's Goddard Mission Services Evolution Center (GMSEC) ground system architecture has been in development since late 2001, has successfully supported eight orbiting satellites and is being applied to many of NASA's future missions. GMSEC can be considered an event-driven service-oriented architecture built around a publish/subscribe message bus middleware. This paper briefly discusses the GMSEC technical approaches which have led to significant cost savings and risk reduction for NASA missions operated at the Goddard Space Flight Center (GSFC). The paper then focuses on the development and operational impacts of extending the architecture across multiple mission operations facilities.

PREMChlor: Probabilistic Remediation Evaluation Model for Chlorinated Solvents

DTIC Science & Technology

2010-03-01

Council O&M Operation & Management PAT pump-and-treat PCE tetrachloroethylene PDFs Probability density functions PRBs Permeable reactive barriers...includes a one-time capital cost and a total operation & management (O&M) cost in present net value (NPV) for a certain remediation period. The...Generally, the costs of plume treatment include the capital cost (treatment volume multiply by the unit cost) and the annual operation & Management (O&M

O&M Best Practices - A Guide to Achieving Operational Efficiency (Release 2.0)

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

Sullivan, Gregory P.; Pugh, Ray; Melendez, Aldo P.

2004-07-31

This guide, sponsored by DOE's Federal Energy Management Program, highlights operations and maintenance (O&M) programs targeting energy efficiency that are estimated to save 5% to 20% on energy bills without a significant capital investment. The purpose of this guide is to provide the federal O&M energy manager and practitioner with useful information about O&M management, technologies, energy efficiency and cost-reduction approaches.

Forest thinnings for integrated lumber and paper production

Treesearch

J.Y. Zhu; C.T. Scott; R. Gleisner; D. Mann; D.W. Vahey; D.P. Dykstra; G.H. Quinn; L.L. Edwards

2007-01-01

Integrated lumber and paper productions using forest thinning materials from U.S. national forests can significantly reduce the cost of prescriptive thinning operations. Many of the trees removed during forest thinnings are in small-diameter classes (diameter at breast height

Taking a Holistic Approach to Sustainability

ERIC Educational Resources Information Center

Girouard, Miles

2011-01-01

The benefits of sustainability go way beyond improving the environment. School districts that choose to build facilities using sustainable principles reap the benefits of environmentally friendly, healthy establishments; attractive work spaces (which improve recruiting and retention); and significant operational cost savings. Districts realize…

Effects of ITS on transit system cost structures

DOT National Transportation Integrated Search

2002-10-01

The operation of public transit system has undergone significant changes over the past five decades. In the 1960s, most U.S. transit systems were privately owned and received little federal assistance. Most transit systems in the United States are cu...

Cost-effectiveness of motivational intervention with significant others for patients with alcohol misuse.

PubMed

Shepard, Donald S; Lwin, Aung K; Barnett, Nancy P; Mastroleo, Nadine; Colby, Suzanne M; Gwaltney, Chad; Monti, Peter M

2016-05-01

To estimate the incremental cost, cost-effectiveness and benefit-cost ratio of incorporating a significant other (SO) into motivational intervention for alcohol misuse. We obtained economic data from the one year with the intervention in full operation for patients in a recent randomized trial. The underlying trial took place at a major urban hospital in the United States. The trial randomized 406 (68.7% male) eligible hazardous drinkers (196 during the economic study) admitted to the emergency department or trauma unit. The motivational interview condition consisted of one in-person session featuring personalized normative feedback. The significant other motivational interview condition comprised one joint session with the participant and SO in which the SO's perspective and support were elicited. We ascertained activities across 445 representative time segments through work sampling (including staff idle time), calculated the incremental cost in per patient of incorporating an SO, expressed the results in 2014 US$, incorporated quality and mortality effects from a closely related trial and derived the cost per quality-adjusted life-year (QALY) gained. From a health system perspective, the incremental cost per patient of adding an SO was $341.09 [95% confidence interval (CI) = $244.44-437.74]. The incremental cost per year per hazardous drinker averted was $3623 (CI = $1777-22,709), the cost per QALY gained $32,200 (CI = $15,800-201,700), and the benefit-cost ratio was 4.73 (95% CI = 0.7-9.66). If adding an SO into the intervention strategy were concentrated during the hours with highest risk or in a trauma unit, it would become even more cost-beneficial. Using criteria established by the World Health Organization (cost-effectiveness below the country's gross domestic product per capita), incorporating a significant other into a patient's motivational intervention for alcohol misuse is highly cost-effective. © 2015 Society for the Study of Addiction.

Entanglement cost under positive-partial-transpose-preserving operations.

PubMed

Audenaert, K; Plenio, M B; Eisert, J

2003-01-17

We study the entanglement cost under quantum operations preserving the positivity of the partial transpose (PPT operations). We demonstrate that this cost is directly related to the logarithmic negativity, thereby providing the operational interpretation for this entanglement measure. As examples we discuss general Werner states and arbitrary bipartite Gaussian states. Then we prove that for the antisymmetric Werner state PPT cost and PPT entanglement of distillation coincide. This is the first example of a truly mixed state for which entanglement manipulation is asymptotically reversible, which points towards a unique entanglement measure under PPT operations.

A nurse-run walk-in clinic: cost-effective alternative to non-urgent emergency department use by the uninsured.

PubMed

Bicki, Alexandra; Silva, Adam; Joseph, Valerie; Handoko, Ryan; Rico, Sheryl-vi; Burns, Jacqueline; Simonelli, Anna; Harrop, Jordan; Nedow, Jennifer; De Groot, Anne S

2013-12-01

Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients' lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic's first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic's operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.

The cost management organization: the next step for materiel management.

PubMed

Schuweiler, R C

1997-06-01

With Materiel Management's transition over the last decade from simple logistics to analysis and cost management, it has gained recognition as a key part of the management team responsible for supplies, equipment, standards, and associated processes to identify, purchase, store, distribute, issue, and dispose of supplies and equipment. The materiel manager's job consists of putting the right product in the right place at the right time and in the right quantity at the best total delivered cost. In this context, Materiel Management has made powerful impacts to lower costs associated with: Distribution--costs have been lowered by actively adopting advanced supply channel management techniques such as primary suppliers, JIT, stockless programs, case cart/custom kit/procedure based delivery systems, modified stockless programs as well as margin management through cost plus, flat fee, or margins paid per activity. Cost of goods--lowered through aggregated purchasing in the forms of regional and national purchasing alliances and local capitation or other gain/risk share programs. Internal process costs--lowered by out-sourcing and/or integrating supplier processes and personnel into operations via partnership approaches. We have also reduced transactional costs through EDI transaction sets and the emerging use of the inter and intranet/electronic commerce, procurement cards, and evaluated receipt settlement processes. De-layering--We have lowered the operating costs of Materiel Management overhead by re-design/re-engineering, resulting in reduced management and greater front line authority. Quality--We have learned to identify and respond to customer and supplier needs by using quality improvement tools and ongoing measurement and monitoring techniques. Through this we have identified the waste of non-beneficial products and services. We have adopted supplier certification measurers to ensure quality is built into processes and outcomes. With so much already accomplished, it should be easy to rest on these laurels and simply operate. However, we believe that this is just a beginning. A new generation of highly educated leaders are emerging and taking advantage of the contributions of pioneers who laid the ground work. These new leaders will have advanced management, statistics, and behavioral sciences skills. They will be analysts and organizational motivators. Their goal will be to improve financial and clinical performance measured by real time process and performance data. The new leaders will have information at their fingertips thanks to significant leaps forward in data collection, automated continuous replenishment processes, and software designed for better management of clinical and cost outcomes. This article documents significant Materiel management accomplishments and conceptualizes cost management processes. The cost management organization is the logical evolution in our efforts for better outcomes in healthcare Materiel management.

The cost of trauma operating theatre inefficiency

PubMed Central

Ang, W.W.; Sabharwal, S.; Johannsson, H.; Bhattacharya, R.; Gupte, C.M.

2016-01-01

The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Mary's Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends. PMID:27047660

The cost of trauma operating theatre inefficiency.

PubMed

Ang, W W; Sabharwal, S; Johannsson, H; Bhattacharya, R; Gupte, C M

2016-05-01

The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Mary's Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends.

Comparing cost-effectiveness of X-Stop with minimally invasive decompression in lumbar spinal stenosis: a randomized controlled trial.

PubMed

Lønne, Greger; Johnsen, Lars Gunnar; Aas, Eline; Lydersen, Stian; Andresen, Hege; Rønning, Roar; Nygaard, Øystein P

2015-04-15

Randomized clinical trial with 2-year follow-up. To compare the cost-effectiveness of X-stop to minimally invasive decompression in patients with symptomatic lumbar spinal stenosis. Lumbar spinal stenosis is the most common indication for operative treatment in elderly. Although surgery is more costly than nonoperative treatment, health outcomes for more than 2 years were shown to be significantly better. Surgical treatment with minimally invasive decompression is widely used. X-stop is introduced as another minimally invasive technique showing good results compared with nonoperative treatment. We enrolled 96 patients aged 50 to 85 years, with symptoms of neurogenic intermittent claudication within 250-m walking distance and 1- or 2-level lumbar spinal stenosis, randomized to either minimally invasive decompression or X-stop. Quality-adjusted life-years were based on EuroQol EQ-5D. The hospital unit costs were estimated by means of the top-down approach. Each cost unit was converted into a monetary value by dividing the overall cost by the amount of cost units produced. The analysis of costs and health outcomes is presented by the incremental cost-effectiveness ratio. The study was terminated after a midway interim analysis because of significantly higher reoperation rate in the X-stop group (33%). The incremental cost for X-stop compared with minimally invasive decompression was &OV0556;2832 (95% confidence interval: 1886-3778), whereas the incremental health gain was 0.11 quality-adjusted life-year (95% confidence interval: -0.01 to 0.23). Based on the incremental cost and effect, the incremental cost-effectiveness ratio was &OV0556;25,700. The majority of the bootstrap samples displayed in the northeast corner of the cost-effectiveness plane, giving a 50% likelihood that X-stop is cost-effective at the extra cost of &OV0556;25,700 (incremental cost-effectiveness ratio) for a quality-adjusted life-year. The significantly higher cost of X-stop is mainly due to implant cost and the significantly higher reoperation rate. 2.

42 CFR 412.71 - Determination of base-year inpatient operating costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Determination of base-year inpatient operating... Costs § 412.71 Determination of base-year inpatient operating costs. (a) Base-year costs. (1) For each... before September 30, 1983 is for less than 12 months, the base period will be the hospital's most recent...

42 CFR 412.71 - Determination of base-year inpatient operating costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Determination of base-year inpatient operating... Costs § 412.71 Determination of base-year inpatient operating costs. (a) Base-year costs. (1) For each... before September 30, 1983 is for less than 12 months, the base period will be the hospital's most recent...

42 CFR 412.71 - Determination of base-year inpatient operating costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Determination of base-year inpatient operating... Costs § 412.71 Determination of base-year inpatient operating costs. (a) Base-year costs. (1) For each... before September 30, 1983 is for less than 12 months, the base period will be the hospital's most recent...

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

PubMed

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

2017-07-01

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

Transonic transport study: Economics

NASA Technical Reports Server (NTRS)

Smith, C. L.; Wilcox, D. E.

1972-01-01

An economic analysis was performed to evaluate the impact of advanced materials, increased aerodynamic and structural efficiencies, and cruise speed on advanced transport aircraft designed for cruise Mach numbers of .90, .98, and 1.15. A detailed weight statement was generated by an aircraft synthesis computer program called TRANSYN-TST; these weights were used to estimate the cost to develop and manufacture a fleet of aircraft of each configuration. The direct and indirect operating costs were estimated for each aircraft, and an average return on investment was calculated for various operating conditions. There was very little difference between the operating economics of the aircraft designed for Mach numbers .90 and .98. The Mach number 1.15 aircraft was economically marginal in comparison but showed significant improvements with the application of carbon/epoxy structural material. However, the Mach .90 and Mach .98 aircraft are the most economically attractive vehicles in the study.

Advanced nickel-hydrogen cell configuration study

NASA Technical Reports Server (NTRS)

1983-01-01

Long-term trends in the evolution of space power technology point toward increased payload power demand which in turn translates into both higher battery system charge storage capability and higher operating voltages. State of the art nickel-hydrogen cells of the 50 to 60 Wh size, packaged in individual pressure vessels, are capable of meeting the required cycle life for a wide range of anticipated operating conditions; however, they provided several drawbacks to battery system integrated efforts. Because of size, high voltage/high power systems require integrating hundreds of cells into the operating system. Packaging related weight and volume inefficiencies degrade the energy density and specific energy of individual cells currently at 30 Wh/cudm and 40 Wh/kg respectively. In addition, the increased parts count and associated handling significantly affect the overall battery related costs. Spacecraft battery systems designers within industry and Government realize that to reduce weight, volume, and cost requires increases in the capacity of nickel-hydrogen cells.

NASA Redox Project status summary

NASA Technical Reports Server (NTRS)

Hagedorn, N. H.

1983-01-01

This report is a summary of the results of the Redox Project effort during Cy 1982. It was presented at the Fifth U.S. Department of Energy Battery and Electrochemical Contractors Conference, Arlington, Va., Dec. 7-9, 1982. The major development during 1982 was the shift from Redox system operation at 25 C with unmixed reactants to operation at 65 C with mixed reactants. This change has made possible a two- or three-fold increase in operating current density, to about 65 mA/sq cm, and an increase in reactant utilization from 40% to about 90%. Both of these improvements will lead to significant system cost reductions. Contract studies have indicated that Redox reactant costs also will be moderate. A new catalyst for the chromuim electrode offers all the advantages of the conventional gold-lead catalyst while being easier to apply and more forgiving in use.

Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

PubMed

Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M

2015-04-01

(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Looped suture versus stapler device in pediatric laparoscopic appendectomy: a comparative outcomes and intraoperative cost analysis.

PubMed

Parikh, Punam P; Tashiro, Jun; Wagenaar, Amy E; Curbelo, Miosotys; Perez, Eduardo A; Neville, Holly L; Hogan, Anthony R; Sola, Juan E

2018-04-01

Appendiceal ligation during pediatric laparoscopic appendectomy (LA) may be performed using looped suture versus stapler. Controversy regarding the utility of either method exists. Clinical outcomes and cost analysis of LA with both methods were compared. All pediatric LA were performed from fiscal years 2013 and 2014 by two pediatric surgeons. While one surgeon used looped suture, the other used stapler exclusively. chi-Square tests were performed to analyze associations. Two hundred thirty-eight cases were analyzed where looped suture versus stapler LA was performed in 46% and 54% of patients, respectively. Operating room costs were $317.10 and $707.12/person for looped suture and stapler LA, respectively (P<0.0001). Difference in cost of $390.02/person was attributed solely to ligation type. On bivariate analysis, rate of in-hospital complications, length of stay, return-to-ER and readmission within 30 days did not significantly differ between groups. A comparative analysis of looped suture versus stapler device during LA for pediatric appendicitis revealed that postoperative complications, length of stay, ER visits and readmissions were not significantly different. Looped suture LA was significantly more cost efficient than stapler LA. In pediatric appendicitis, appendiceal ligation during LA may be performed safely and cost effectively with looped suture versus stapler. Cost effectiveness LEVEL OF EVIDENCE: III. Copyright © 2017 Elsevier Inc. All rights reserved.

Cost Benefit Analysis: Closed-Cell Polyurethane Foam Use in DOD Forward-Deployed Structures and As An Alternative Building Material to Reduce Operational Fuel Demand and Associated Costs

DTIC Science & Technology

2015-06-01

23 6. Disposal ...............................................................................................23 7. Health Hazards ...component spray foams, to as much as 8 to 24 hours for OCSF or CCSF. Due to the significant health hazards , the EPA stresses to err on the side of... Hazards and Concerns The EPA has indicated that there are serious health risks associated with the airborne aerosols, mists, and vapors that result

Aquatic Plant Control Research Program: Proceedings Annual Meeting (28th) Held in Baltimore, Maryland on November 15-18, 1993

DTIC Science & Technology

1994-06-01

the system could be operated to de- to user-defined evaluation criteria, such as termine the advantages and disadvantages of costs, longevity ...statistical analysis (means, range, regression, information on control approach for cost, and significance tests) and plot capability longevity , degree of...and Matthews, Spencer, D. F. (1986). "Tuber demography M. S. (1982). "Growth and morphology and its consequences for Potamogeton of submersed

Holmium laser enucleation versus laparoscopic simple prostatectomy for large adenomas.

PubMed

Juaneda, R; Thanigasalam, R; Rizk, J; Perrot, E; Theveniaud, P E; Baumert, H

2016-01-01

The aim of this study is to compare Holmium laser enucleation of the prostate with another minimally invasive technique, the laparoscopic simple prostatectomy. We compared outcomes of a series of 40 patients who underwent laparoscopic simple prostatectomy (n=20) with laser enucleation of the prostate (n=20) for large adenomas (>100 grams) at our institution. Study variables included operative time and catheterization time, hospital stay, pre- and post-operative International Prostate Symptom Score and maximum urinary flow rate, complications and economic evaluation. Statistical analyses were performed using the Student t test and Fisher test. There were no significant differences in patient age, preoperative prostatic size, operating time or specimen weight between the 2 groups. Duration of catheterization (P=.0008) and hospital stay (P<.0001) were significantly less in the laser group. Both groups showed a statistically significant improvement in functional variables at 3 months post operatively. The cost utility analysis for Holmium per case was 2589 euros versus 4706 per laparoscopic case. In the laser arm, 4 patients (20%) experienced complications according to the modified Clavien classification system versus 5 (25%) in the laparoscopic group (P>.99). Holmium enucleation of the prostate has similar short term functional results and complication rates compared to laparoscopic simple prostatectomy performed in large glands with the advantage of less catheterization time, lower economic costs and a reduced hospital stay. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery.

PubMed

Arsenault, Kyle A; Yusuf, Arif M; Crystal, Eugene; Healey, Jeff S; Morillo, Carlos A; Nair, Girish M; Whitlock, Richard P

2013-01-31

Atrial fibrillation is a common post-operative complication of cardiac surgery and is associated with an increased risk of post-operative stroke, increased length of intensive care unit and hospital stays, healthcare costs and mortality. Numerous trials have evaluated various pharmacological and non-pharmacological prophylactic interventions for their efficacy in preventing post-operative atrial fibrillation. We conducted an update to a 2004 Cochrane systematic review and meta-analysis of the literature to gain a better understanding of the effectiveness of these interventions. The primary objective was to assess the effects of pharmacological and non-pharmacological interventions for preventing post-operative atrial fibrillation or supraventricular tachycardia after cardiac surgery. Secondary objectives were to determine the effects on post-operative stroke or cerebrovascular accident, mortality, cardiovascular mortality, length of hospital stay and cost of treatment during the hospital stay. We searched the Cochrane Central Register of ControlLed Trials (CENTRAL) (Issue 8, 2011), MEDLINE (from 1946 to July 2011), EMBASE (from 1974 to July 2011) and CINAHL (from 1981 to July 2011). We selected randomized controlled trials (RCTs) that included adult patients undergoing cardiac surgery who were allocated to pharmacological or non-pharmacological interventions for the prevention of post-operative atrial fibrillation or supraventricular tachycardia, except digoxin, potassium (K(+)), or steroids. Two review authors independently abstracted study data and assessed trial quality. One hundred and eighteen studies with 138 treatment groups and 17,364 participants were included in this review. Fifty-seven of these studies were included in the original version of this review while 61 were added, including 27 on interventions that were not considered in the original version. Interventions included amiodarone, beta-blockers, sotalol, magnesium, atrial pacing and posterior pericardiotomy. Each of the studied interventions significantly reduced the rate of post-operative atrial fibrillation after cardiac surgery compared with a control. Beta-blockers (odds ratio (OR) 0.33; 95% confidence interval) CI 0.26 to 0.43; I(2) = 55%) and sotalol (OR 0.34; 95% CI 0.26 to 0.43; I(2) = 3%) appear to have similar efficacy while magnesium's efficacy (OR 0.55; 95% CI 0.41 to 0.73; I(2) = 51%) may be slightly less. Amiodarone (OR 0.43; 95% CI 0.34 to 0.54; I(2) = 63%), atrial pacing (OR 0.47; 95% CI 0.36 to 0.61; I(2) = 50%) and posterior pericardiotomy (OR 0.35; 95% CI 0.18 to 0.67; I(2) = 66%) were all found to be effective. Prophylactic intervention decreased the hospital length of stay by approximately two-thirds of a day and decreased the cost of hospital treatment by roughly $1250 US. Intervention was also found to reduce the odds of post-operative stroke, though this reduction did not reach statistical significance (OR 0.69; 95% CI 0.47 to 1.01; I(2) = 0%). No significant effect on all-cause or cardiovascular mortality was demonstrated. Prophylaxis to prevent atrial fibrillation after cardiac surgery with any of the studied pharmacological or non-pharmacological interventions may be favored because of its reduction in the rate of atrial fibrillation, decrease in the length of stay and cost of hospital treatment and a possible decrease in the rate of stroke. However, this review is limited by the quality of the available data and heterogeneity between the included studies. Selection of appropriate interventions may depend on the individual patient situation and should take into consideration adverse effects and the cost associated with each approach.

Cost and risk assessment for spacecraft operation decisions caused by the space debris environment

NASA Astrophysics Data System (ADS)

Schaub, Hanspeter; Jasper, Lee E. Z.; Anderson, Paul V.; McKnight, Darren S.

2015-08-01

Space debris is a topic of concern among many in the space community. Most forecasting analyses look centuries into the future to attempt to predict how severe debris densities and fluxes will become in orbit regimes of interest. Conversely, space operators currently do not treat space debris as a major mission hazard. This survey paper outlines the range of cost and risk evaluations a space operator must consider when determining a debris-related response. Beyond the typical direct costs of performing an avoidance maneuver, the total cost including indirect costs, political costs and space environmental costs are discussed. The weights on these costs can vary drastically across mission types and orbit regimes flown. The operator response options during a mission are grouped into four categories: no action, perform debris dodging, follow stricter mitigation, and employ ADR. Current space operations are only considering the no action and debris dodging options, but increasing debris risk will eventually force the stricter mitigation and ADR options. Debris response equilibria where debris-related risks and costs settle on a steady-state solution are hypothesized.

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

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

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

2010-06-01

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

Sensitivities and Tipping Points of Power System Operations to Fluctuations Caused by Water Availability and Fuel Prices

NASA Astrophysics Data System (ADS)

O'Connell, M.; Macknick, J.; Voisin, N.; Fu, T.

2017-12-01

The western US electric grid is highly dependent upon water resources for reliable operation. Hydropower and water-cooled thermoelectric technologies represent 67% of generating capacity in the western region of the US. While water resources provide a significant amount of generation and reliability for the grid, these same resources can represent vulnerabilities during times of drought or low flow conditions. A lack of water affects water-dependent technologies and can result in more expensive generators needing to run in order to meet electric grid demand, resulting in higher electricity prices and a higher cost to operate the grid. A companion study assesses the impact of changes in water availability and air temperatures on power operations by directly derating hydro and thermo-electric generators. In this study we assess the sensitivities and tipping points of water availability compared with higher fuel prices in electricity sector operations. We evaluate the impacts of varying electricity prices by modifying fuel prices for coal and natural gas. We then analyze the difference in simulation results between changes in fuel prices in combination with water availability and air temperature variability. We simulate three fuel price scenarios for a 2010 baseline scenario along with 100 historical and future hydro-climate conditions. We use the PLEXOS electricity production cost model to optimize power system dispatch and cost decisions under each combination of fuel price and water constraint. Some of the metrics evaluated are total production cost, generation type mix, emissions, transmission congestion, and reserve procurement. These metrics give insight to how strained the system is, how much flexibility it still has, and to what extent water resource availability or fuel prices drive changes in the electricity sector operations. This work will provide insights into current electricity operations as well as future cases of increased penetration of variable renewable generation technologies such as wind and solar.

'No matter what the cost': A qualitative study of the financial costs faced by family and whānau caregivers within a palliative care context.

PubMed

Gott, Merryn; Allen, Ruth; Moeke-Maxwell, Tess; Gardiner, Clare; Robinson, Jackie

2015-06-01

There has been significant attention paid in recent years to the economic costs of health service provision for people with palliative care needs. However, little is known about the costs incurred by family caregivers who typically provide the bulk of care for people at the end of life. To explore the nature and range of financial costs incurred by family caregiving within a palliative care context. In-depth qualitative interviews were conducted with 30 family/whānau caregivers who were currently caring for someone with a life-limiting illness or had done so within the preceding year. Narrative analysis was used to identify impacts and costs at the personal, interpersonal, sociocultural and structural levels. Auckland, New Zealand. Costs of caregiving were significant and, for participants, resulted in debt or even bankruptcy. A range of direct (transport, food and medication) and indirect costs (related to employment, cultural needs and own health) were reported. A multi-level qualitative analysis revealed how costs operated at a number of levels (personal, interpersonal, sociocultural and structural). The palliative care context increased costs, as meeting needs were prioritised over cost. In addition, support from statutory service providers to access sources of financial support was limited. Families incur significant financial costs when caring for someone at the end of life. Research is now needed to quantify the financial contribution of family and whānau caregiving within a palliative care context, particularly given attempts in many countries to shift more palliative care provision into community settings. © The Author(s) 2015.