WorldWideScience

Sample records for case mix costing

  1. Case mix, quality and high-cost kidney transplant patients.

    Science.gov (United States)

    Englesbe, M J; Dimick, J B; Fan, Z; Baser, O; Birkmeyer, J D

    2009-05-01

    A better understanding of high-cost kidney transplant patients would be useful for informing value-based purchasing strategies by payers. This retrospective cohort study was based on the Medicare Provider Analysis and Review (MEDPAR) files from 2003 to 2006. The focus of this analysis was high-cost kidney transplant patients (patients that qualified for Medicare outlier payments and 30-day readmission payments). Using regression techniques, we explored relationships between high-cost kidney transplant patients, center-specific case mix, and center quality. Among 43 393 kidney transplants in Medicare recipients, 35.2% were categorized as high-cost patients. These payments represented 20% of total Medicare payments for kidney transplantation and exceeded $200 million over the study period. Case mix was associated with these payments and was an important factor underlying variation in hospital payments high-cost patients. Hospital quality was also a strong determinant of future Medicare payments for high-cost patients. Compared to high-quality centers, low-quality centers cost Medicare an additional $1185 per kidney transplant. Payments for high-cost patients represent a significant proportion of the total costs of kidney transplant surgical care. Quality improvement may be an important strategy for reducing the costs of kidney transplantation.

  2. Case Mix, Quality and High-Cost Kidney Transplant Patients

    OpenAIRE

    Englesbe, M. J.; Dimick, J. B.; Fan, Z; Baser, O.; Birkmeyer, J. D.

    2009-01-01

    A better understanding of high-cost kidney transplant patients would be useful for informing value-based purchasing strategies by payers. This retrospective cohort study was based on the Medicare Provider Analysis and Review (MEDPAR) files from 2003 to 2006. The focus of this analysis was high-cost kidney transplant patients (patients that qualified for Medicare outlier payments and 30-day readmission payments). Using regression techniques, we explored relationships between high-cost kidney t...

  3. Practice patterns, case mix, Medicare payment policy, and dialysis facility costs.

    Science.gov (United States)

    Hirth, R A; Held, P J; Orzol, S M; Dor, A

    1999-02-01

    To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment

  4. The impact of payer-specific hospital case mix on hospital costs and revenues for third-party patients.

    Science.gov (United States)

    Lee, Keon-Hyung; Roh, M P H Chul-Young

    2007-02-01

    Competition among hospitals and managed care have forced hospital industry to be more efficient. With higher degrees of hospital competition and managed care penetration, hospitals have argued that the rate of increase in hospital cost is greater than the rate of increase in hospital revenue. By developing a payer-specific case mix index (CMI) for third-party patients, this paper examined the effect of hospital case mix on hospital cost and revenue for third-party patients in California using the hospital financial and utilization data covering 1986-1998. This study found that the coefficients for CMIs in the third-party hospital revenue model were greater than those in the hospital cost model until 1995. Since 1995, however, the coefficients for CMIs in the third-party hospital revenue model have been less than those in hospital cost models. Over time, the differences in coefficients for CMIs in hospital revenue and cost models for third-party patients have become smaller and smaller although those differences are statistically insignificant.

  5. The high cost of hospital trauma care: an analysis of hospital length of stay, injury severity score, case mix index, and reimbursement-to-cost ratio.

    Science.gov (United States)

    Legorreta, A P; Mikos, J; Sullivan, A; Delany, H M

    1993-01-01

    We conducted a study to evaluate reimbursement characteristics for an urban hospital providing a high volume of trauma care. Complete clinical and financial data for 209 trauma patients admitted to the Bronx Municipal Hospital Center during September 1990 were entered into a trauma registry. Patients were categorized into three groups. Group 1 fulfilled criteria for reimbursement using the New York State Major Diagnostic Category 25 (NYSMDC 25) for trauma. Group 2 patients fulfilled New York City Emergency Medical Service 911 criteria for transport to a level 1 trauma center. Group 3 patients did not fit either category. Analysis included age, race, sex, length of stay, injury severity score, case mix index, payer source, and reimbursement-to-cost ratio. Of the patients studied, 77.5% were men. Hispanic, African-American, and white patients constituted 40.2%, 26.3%, and 17.2%, respectively, of the study population. The payer mix was 36.6% Medicaid; 20.8% self-pay; 19.1% no fault; 9.6% Blue Cross; 5.5% Medicare; 5% commercial; and 3.3% other. The study demonstrated that criteria for group 1 and group 2 define patients who constitute a distinct clinical group by injury severity score. As expected, the length of stay and case mix index were significantly higher for group 1, but they did not differ between group 2 and group 3. Group 1 was a small proportion (7.7%) of trauma patients admitted to the Bronx Municipal Hospital Center level 1 trauma center. Trauma admissions were treated at a net loss, with a projected high annual deficit of $5.3 million.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Research misconduct oversight: defining case costs.

    Science.gov (United States)

    Gammon, Elizabeth; Franzini, Luisa

    2013-01-01

    This study uses a sequential mixed method study design to define cost elements of research misconduct among faculty at academic medical centers. Using time driven activity based costing, the model estimates a per case cost for 17 cases of research misconduct reported by the Office of Research Integrity for the period of 2000-2005. Per case cost of research misconduct was found to range from $116,160 to $2,192,620. Research misconduct cost drivers are identified.

  7. The relationship between effectiveness and costs measured by a risk-adjusted case-mix system: multicentre study of Catalonian population data bases

    Directory of Open Access Journals (Sweden)

    Flor-Serra Ferran

    2009-06-01

    Full Text Available Abstract Background The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. Methods/Design We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit, dependent variables (mean number of visits, episodes and direct costs, co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System and effectiveness. The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others, referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization. The model of cost/patient/year will differentiate fixed/semi-fixed (visits costs of the variables for each patient attended/year (N = 350,000 inhabitants. The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50. The correlation between the efficiency (relative-weights and synthetic (by centre and physician indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000 will be measured using a structured questionnaire including various dimensions. Statistical analysis: multiple regression

  8. Interpreting cost of ownership for mix-and-match lithography

    Science.gov (United States)

    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.

  9. Nursing home staffing, turnover, and case mix.

    Science.gov (United States)

    Harrington, Charlene; Swan, James H

    2003-09-01

    This study examined the predictors of total nurse and registered nurse (RN) staffing hours per resident day separately in all free-standing California nursing homes (1,555), using staffing data from state cost reports in 1999. This study used a two-stage least squares model, taking into account nursing turnover rates, resident case mix levels, and other factors. As expected, total nurse and RN staffing hours were negatively associated with nurse staff turnover rates and positively associated with resident case mix. Facilities were resource dependent in that a high proportion of Medicare residents predicted higher staffing hours, and a higher proportion of Medicaid residents predicted lower staffing hours and higher turnover rates. Nursing assistant wages were positively associated with total nurse staffing hours. For-profit facilities and high-occupancy rate facilities had lower total nurse and RN staffing hours. Medicaid reimbursement rates and multifacility organizations were positively associated with RN staffing hours.

  10. Hospital Case Cost Estimates Modelling - Algorithm Comparison

    CERN Document Server

    Andru, Peter

    2008-01-01

    Ontario (Canada) Health System stakeholders support the idea and necessity of the integrated source of data that would include both clinical (e.g. diagnosis, intervention, length of stay, case mix group) and financial (e.g. cost per weighted case, cost per diem) characteristics of the Ontario healthcare system activities at the patient-specific level. At present, the actual patient-level case costs in the explicit form are not available in the financial databases for all hospitals. The goal of this research effort is to develop financial models that will assign each clinical case in the patient-specific data warehouse a dollar value, representing the cost incurred by the Ontario health care facility which treated the patient. Five mathematical models have been developed and verified using real dataset. All models can be classified into two groups based on their underlying method: 1. Models based on using relative intensity weights of the cases, and 2. Models based on using cost per diem.

  11. Reactive control processes contributing to residual switch cost and mixing cost across the adult lifespan.

    Science.gov (United States)

    Whitson, Lisa R; Karayanidis, Frini; Fulham, Ross; Provost, Alexander; Michie, Patricia T; Heathcote, Andrew; Hsieh, Shulan

    2014-01-01

    In task-switching paradigms, performance is better when repeating the same task than when alternating between tasks (switch cost) and when repeating a task alone rather than intermixed with another task (mixing cost). These costs remain even after extensive practice and when task cues enable advanced preparation (residual costs). Moreover, residual reaction time mixing cost has been consistently shown to increase with age. Residual switch and mixing costs modulate the amplitude of the stimulus-locked P3b. This mixing effect is disproportionately larger in older adults who also prepare more for and respond more cautiously on these "mixed" repeat trials (Karayanidis et al., 2011). In this paper, we analyze stimulus-locked and response-locked P3 and lateralized readiness potentials to identify whether residual switch and mixing cost arise from the need to control interference at the level of stimulus processing or response processing. Residual mixing cost was associated with control of stimulus-level interference, whereas residual switch cost was also associated with a delay in response selection. In older adults, the disproportionate increase in mixing cost was associated with greater interference at the level of decision-response mapping and response programming for repeat trials in mixed-task blocks. These findings suggest that older adults strategically recruit greater proactive and reactive control to overcome increased susceptibility to post-stimulus interference. This interpretation is consistent with recruitment of compensatory strategies to compensate for reduced repetition benefit rather than an overall decline on cognitive flexibility.

  12. Life Cycle Cost Analysis of Ready Mix Concrete Plant

    Science.gov (United States)

    Topkar, V. M.; Duggar, A. R.; Kumar, A.; Bonde, P. P.; Girwalkar, R. S.; Gade, S. B.

    2013-11-01

    India, being a developing nation is experiencing major growth in its infrastructural sector. Concrete is the major component in construction. The requirement of good quality of concrete in large quantities can be fulfilled by ready mix concrete batching and mixing plants. The paper presents a technique of applying the value engineering tool life cycle cost analysis to a ready mix concrete plant. This will help an investor or an organization to take investment decisions regarding a ready mix concrete facility. No economic alternatives are compared in this study. A cost breakdown structure is prepared for the ready mix concrete plant. A market survey has been conducted to collect realistic costs for the ready mix concrete facility. The study establishes the cash flow for the ready mix concrete facility helpful in investment and capital generation related decisions. Transit mixers form an important component of the facility and are included in the calculations. A fleet size for transit mixers has been assumed for this purpose. The life cycle cost has been calculated for the system of the ready mix concrete plant and transit mixers.

  13. Reactive control processes contributing to residual switch cost and mixing cost in young and old adults

    Directory of Open Access Journals (Sweden)

    Lisa Rebecca Whitson

    2014-04-01

    Full Text Available In task-switching paradigms, performance is better when repeating the same task than when alternating between tasks (switch cost and when repeating a task alone rather than intermixed with another task (mixing cost. These costs remain even after extensive practice and when task cues enable advanced preparation (residual costs. Moreover, residual RT mixing cost has been consistently shown to increase with age. Residual switch and mixing costs modulate the amplitude of the stimulus-locked P3b. This mixing effect is disproportionately larger in older adults who also prepare more for and respond more cautiously on these ‘mixed’ repeat trials (Karayanidis et al., 2011. In this study, we examine stimulus-locked and response-locked P3 and lateralized readiness potentials to identify whether residual switch and mixing cost arise from the need to control interference at the level of stimulus processing or response processing. Residual mixing cost was associated with control of stimulus-level interference, whereas residual switch cost was also associated with a delay in response selection. In older adults, the disproportionate increase in mixing cost was associated with greater interference at the level of decision-response mapping and response programming for repeat trials in mixed-task blocks. We argue that, together with evidence of greater proactive control and more cautious responding for these trials, these findings suggest that older adults strategically recruit greater proactive and reactive control to overcome increased susceptibility to post-stimulus interference. This interpretation is consistent with recruitment of compensatory strategies to compensate for reduced repetition benefit rather than an overall decline on cognitive flexibility.

  14. Avoidable costs of comprehensive case management.

    Science.gov (United States)

    Issel, L M; Anderson, R A

    1999-01-01

    Comprehensive case management has become an industry standard and its pervasiveness raises questions about the ubiquitous need for this service. Analyzed from the perspective of transaction cost analysis and access, we argue that in some cases comprehensive case management is an avoidable cost incurred because of system problems that limit access to otherwise eligible clients. Implications are discussed.

  15. Mixed H2/H∞ Optimal Guaranteed Cost Control of Uncertain Linear Systems

    Institute of Scientific and Technical Information of China (English)

    GuodingChen; MayingYang; LiYu

    2004-01-01

    The mixed H2/H∞ guaranteed cost control problem via state feedback control laws is considered in this paper for linear systems with norm-bounded parameter uncertainty. Based on the linear matrix inequality (LMI) approach, sufficient conditions are derived for the existence of guaranteed cost controllers whihc guarantee not only a prespecified H∞ disturbance attenuation level on one controlled output for all admissible parameter uncertainties, but also the worst-case H2 performance index on the other controlled output to be no more than a specified bound. Furthermore, a convex optimization problem is formulated to design an optimal H2/H∞ guaranteed cost controller.

  16. Mixed salmonella infection - A case report

    Directory of Open Access Journals (Sweden)

    Joshi S

    2002-01-01

    Full Text Available Mixed infection with multiple Salmonella serotypes in the same patient is an unusual finding. We present a case of enteric fever in which the blood culture was sterile and Widal test was negative. The culture of the bone marrow yielded Salmonella typhi and Salmonella paratyphi A.

  17. How costs influence decision values for mixed outcomes

    Directory of Open Access Journals (Sweden)

    Deborah eTalmi

    2012-10-01

    Full Text Available The things that we hold dearest often require a sacrifice, as epitomized in the maxim ‘no pain, no gain’. But how is the subjective value of outcomes established when they consist of mixtures of costs and benefits? We describe theoretical models for the integration of costs and benefits into a single value, drawing on both the economic and the empirical literatures, with the goal of rendering them accessible to the neuroscience community. We propose two key assays that go beyond goodness of fit for deciding between the dominant additive model and four varieties of interactive models. First, how they model decisions between costs when reward is not on offer; and second, whether they predict changes in reward sensitivity when costs are added to outcomes, and in what direction. We provide a selective review of relevant neurobiological work from a computational perspective, focusing on those studies that illuminate the underlying valuation mechanisms. Cognitive neuroscience has great potential to decide which of the theoretical models is actually employed by our brains, but empirical work has yet to fully embrace this challenge. We hope that future research would improve our understanding of how our brain decides whether mixed outcomes are worthwhile.

  18. A Mixed Methods Sampling Methodology for a Multisite Case Study

    Science.gov (United States)

    Sharp, Julia L.; Mobley, Catherine; Hammond, Cathy; Withington, Cairen; Drew, Sam; Stringfield, Sam; Stipanovic, Natalie

    2012-01-01

    The flexibility of mixed methods research strategies makes such approaches especially suitable for multisite case studies. Yet the utilization of mixed methods to select sites for these studies is rarely reported. The authors describe their pragmatic mixed methods approach to select a sample for their multisite mixed methods case study of a…

  19. ROMI 3.1 Least-cost lumber grade mix solver using open source statistical software

    Science.gov (United States)

    Rebecca A. Buck; Urs Buehlmann; R. Edward. Thomas

    2010-01-01

    The least-cost lumber grade mix solution has been a topic of interest to both industry and academia for many years due to its potential to help wood processing operations reduce costs. A least-cost lumber grade mix solver is a rough mill decision support system that describes the lumber grade or grade mix needed to minimize raw material or total production cost (raw...

  20. MixBC Method: a New Approach for Distribution of Indirect Costs and Expenses to Products

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Pereira Soares

    2013-02-01

    Full Text Available In cost management, the products cost is a valuable and necessary information. Nevertheless, distributing indirect costs and expenses to products may involve several uncertainties, what can lead to imprecise results and decision mistakes. The aim of this paper is to construct a method that would reduce the uncertainties found in current costing processes, by modelling and providing the analytical deduction of the method MixBC – Mix Based Costing. In sequence, there was performed an example of construction projects costing using MixBC. By analysing different production scenarios, this method permits indirect costs and expenses to be distributed among the products without the need of arbitrary apportionment.

  1. The case for implementing activity based costing.

    Science.gov (United States)

    Monge, Paul H; Bolinger-Perez, Nicole; Boysen, Kent

    2012-01-01

    ABC identifies profitable volumes to give managers information to better manage volumes. Managers must balance the demand for service while maintaining a reasonable profit margin. Disparate systems work extremely well for their intended purposes, but they do not communicate with one another. The strength of the data they hold individually may be leveraged when implementing ABC methodology. Mayo Clinic in Rochester, Minnesota implemented a pilot of ABC to evaluate CT services where there is a high volume, multiple service location for cost comparison, variety of patient acuity and service mix, and large capital investments.The goal was to reveal the actual cost of CT services at the procedural level.

  2. Design Case Summary. Production of Mixed Alcohols from Municipal Solid Waste via Gasification

    Energy Technology Data Exchange (ETDEWEB)

    Valkenburg, C. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Zhu, Y. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Walton, C. W. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Thompson, B. L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Gerber, M. A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Jones, S. B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Stevens, D. J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2010-03-01

    The Biomass Program develops design cases to understand the current state of conversion technologies and to determine where improvements need to take place in the future. This design case establishes cost targets for converting MSW to ethanol and other mixed alcohols via gasification.

  3. Case-mix adjustment for diabetes indicators: a systematic review

    NARCIS (Netherlands)

    Calsbeek, H.; Markhorst, J.G.M.; Voerman, G.E.; Braspenning, J.C.

    2016-01-01

    OBJECTIVES: Case-mix adjustment is generally considered indispensable for fair comparison of healthcare performance. Inaccurate results are also unfair to patients as they are ineffective for improving quality. However, little is known about what factors should be adjusted for. We reviewed case-mix

  4. Logistics opportunity costs: A mining case study

    Directory of Open Access Journals (Sweden)

    Leani van Jaarsveld

    2013-05-01

    Full Text Available This study highlighted the importance of determining the impact that an ineffective mode of transport has on a firm’s transportation model and costs. The main focus of this study was to determine the logistics opportunity costs of using road transport within a mining firm. A case study approach was followed, as the investigation aimed to analyse a complex problem experienced by one company and present it in an easily understandable format. From the results of this study, it was apparent that the logistics opportunity costs associated with the mode of transport was substantial. This highlighted the need for firms to revise their choice of transport mode on a regular basis, as it has a major impact not only on their transportation costs, but also on their inventory holding and carbon emissions. The results also have implications for South Africa’s only freight railway, Transnet Freight Rail, which should not only focus on expanding its existing capacity, but also on improving its customer service delivery whilst containing tariff increases.

  5. Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care

    Directory of Open Access Journals (Sweden)

    Kronogård Maria

    2009-09-01

    Full Text Available Abstract Background Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Methods Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000 listed with public PHC (approx. 120,000 for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Results Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. Conclusion The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

  6. Electrophysiological correlates of the cognitive control processes underpinning mixing and switching costs.

    Science.gov (United States)

    Tarantino, Vincenza; Mazzonetto, Ilaria; Vallesi, Antonino

    2016-09-01

    Typically, in task-switching contexts individuals are slower and less accurate when repeating a task in mixed blocks compared to single-task blocks (mixing cost) and when switching to a new task compared to repeating a previous one (switch cost). Previous research has shown that distinct electrophysiological correlates underlie these two phenomena. However, this evidence is not a consistent result. The goal of this study was to better characterize differences between the control processes involved in mixing and switch costs. To this aim, we examined event-related potentials (ERPs) evoked during a cued task-switching experiment. In order to minimize the confounding effects of cognitive demands unrelated to task-switching, we asked participants to shift between two simple tasks (a letter identity task and a letter position task). The mixing cost was defined, in terms of ERPs, by contrasting repeat and single-task trials, whereas the ERP switch cost was obtained from the comparison of switch and repeat trials. Cue-locked ERPs showed that the mixing cost was mediated by two sustained components, an early posterior positivity and a late anterior negativity. On the other hand, the switch cost was associated with two early phasic positive components, one principally distributed over centro-parietal sites and the other located over left posterior sites. In target-locked ERPs the mixing cost was expressed by a frontal positivity, whereas the switch cost was expressed by a reduced parietal P3b. Overall, the results extend previous findings by providing elucidating ERP evidence on distinct proactive and reactive control processes involved in mixing and switch costs.

  7. Mixed sensitivity design: An aerospace case study

    NARCIS (Netherlands)

    Kwakernaak, Huibert; Camacho, E.F.; Basanez, L.; Puente, de la J.A.

    2002-01-01

    The mixed sensitivity design method for multivariable linear control systems proposed in the companion paper (Kwakernaak, 2001) is applied to the design of a stability augmentation system for the longitudinal motion of a fighter airplane previously studied by Safonov and Chiang (1988). Both $H_\\inft

  8. prediction of concrete mix cost using modified regression theory

    African Journals Online (AJOL)

    Kambula

    2013-07-02

    Jul 2, 2013 ... The concrete cost analysis is based on the current market prices of concrete constituent materials. A Price Fluctuation Factor (PFF) can be used to take care of ... techniques to fit empirical models to the data for each ...

  9. Case mix planning in hospitals: a review and future agenda.

    Science.gov (United States)

    Hof, Sebastian; Fügener, Andreas; Schoenfelder, Jan; Brunner, Jens O

    2017-06-01

    The case mix planning problem deals with choosing the ideal composition and volume of patients in a hospital. With many countries having recently changed to systems where hospitals are reimbursed for patients according to their diagnosis, case mix planning has become an important tool in strategic and tactical hospital planning. Selecting patients in such a payment system can have a significant impact on a hospital's revenue. The contribution of this article is to provide the first literature review focusing on the case mix planning problem. We describe the problem, distinguish it from similar planning problems, and evaluate the existing literature with regard to problem structure and managerial impact. Further, we identify gaps in the literature. We hope to foster research in the field of case mix planning, which only lately has received growing attention despite its fundamental economic impact on hospitals.

  10. Mixed germ cell tumors: Report of two cases

    Directory of Open Access Journals (Sweden)

    Pradhan M Pagaro

    2013-01-01

    Full Text Available Germ cell tumors arise in the ovaries and testis and rarely in other tissues. Mixed germ cell tumors are rare. We report two cases of mixed germ cell tumors, one consisting of seminoma and immature teratoma in the testis of a 30-year-old male and second consisting of a yolk sac tumor and immature teratoma in the ovary of a 17-year-old female. Many combinations of mixed germ cell tumors have been reported but very few cases of the above-mentioned combinations have been reported in literature.

  11. Mixed Reality Cultural Heritage Communication - The Zea Case

    DEFF Research Database (Denmark)

    Veirum, Niels Einar; Christensen, Mogens Fiil; Mayerhofer, Mikkel

    ”. The poster presents an actual experience design case in Zea Harbour, Greece dealing with these challenges using mixed reality communicating cultural heritage material. Archaeological findings, physical reconstructions and digital models are mixed to effectively stage the interactive experience space. The Zea...... Case is a design scenario for the Museum of the Future showing how Cultural Heritage institutions can use a Glocal Approach to technology and architecture to reinvent the relation to the visitor and the neighbourhood. While Mixed Reality can be used for Cultural Heritage Communication in traditional...

  12. Waste Management Facilities cost information for mixed low-level waste. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Shropshire, D.; Sherick, M.; Biadgi, C.

    1995-06-01

    This report contains preconceptual designs and planning level life-cycle cost estimates for managing mixed low-level waste. The report`s information on treatment, storage, and disposal modules can be integrated to develop total life-cycle costs for various waste management options. A procedure to guide the US Department of Energy and its contractor personnel in the use of cost estimation data is also summarized in this report.

  13. Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care

    Science.gov (United States)

    Fusco, Francesco; Turchetti, Giuseppe

    2016-01-01

    Objectives To assess cost-effectiveness and cost utility of telerehabilitation (TR) versus standard rehabilitation (SR) after total knee replacement (TKR). Design Markov decision modelling of cost-effectiveness and cost-utility analysis based on patient-level and secondary data sources employing Italian National Health Service (NHS; Ita-NHS) and Society perspectives. Setting Primary care units (PCUs) in Italy. Participants Patients discharged after TKR. Interventions Mixed SR-TR service (10 face-to-face sessions and 10 telesessions) versus SR (20 face-to-face sessions) Primary and secondary outcome measures The incremental cost per additional knee flexion range of motion (ROM) and per QALY gained by SR-TR compared with SR. Second, we considered the probability of being cost-effective and the probability of being more effective and less expensive. Results TR appears to be the cost-effective in the base case and in all of the considered scenarios, but is no longer more effective and less expensive if transportation costs are excluded. Comparing SR-TR with SR, the incremental cost-effectiveness ratio (ICER) adopting the Ita-NHS perspective for the base case was −€117/ROM gained. The cost-effectiveness probability for SR-TR was 0.98 (ceiling ratio: €50/ROM), while the joint probability of being more effective and less expensive was 0.87. Assuming that TR would increase health-related quality of life (HRQOL) utilities by 2.5%, the ICER adopting Ita-NHS perspective is −€960/QALY (cost-effectiveness probability: 1; ceiling ratio: €30 000/QALY). All the performed sensitivity analyses did not change the conclusions, but if transportation costs were excluded, the probability for SR-TR of being more clinically effective and less expensive reduced to 0.56. Conclusions The analysis suggested SR-TR to be cost-effective, even less expensive and more effective if the PCUs provide ambulance transportations. However, the uncertainty related to TR costs, HRQOL and long

  14. Fuzzy case based reasoning in sports facilities unit cost estimating

    Science.gov (United States)

    Zima, Krzysztof

    2016-06-01

    This article presents an example of estimating costs in the early phase of the project using fuzzy case-based reasoning. The fragment of database containing descriptions and unit cost of sports facilities was shown. The formulas used in Case Based Reasoning method were presented, too. The article presents similarity measurement using a few formulas, including fuzzy similarity. The outcome of cost calculations based on CBR method was presented as a fuzzy number of unit cost of construction work.

  15. Cost Estimating Cases: Educational Tools for Cost Analysts

    Science.gov (United States)

    1993-09-01

    DATE: 22 Jul 9X WBS ELEMENT/NUM JR: Systems Engineering/Program Mangement /1070 PRODUCTION BRIEF DESCRIPTION: The estimating/technical teams evaluated...Overcoming a Weakness of the Case Method," Cornell Hotel and Restaurant Administration Ouarterly, 3:69-72 (August 1992). 14. Takekuwa, Laura. Budget Course

  16. Case-mix adjustment for diabetes indicators: a systematic review.

    Science.gov (United States)

    Calsbeek, Hiske; Markhorst, Joekle G M; Voerman, Gerlienke E; Braspenning, Jozé C C

    2016-02-01

    Case-mix adjustment is generally considered indispensable for fair comparison of healthcare performance. Inaccurate results are also unfair to patients as they are ineffective for improving quality. However, little is known about what factors should be adjusted for. We reviewed case-mix factors included in adjustment models for key diabetes indicators, the rationale for their inclusion, and their impact on performance. Systematic review. This systematic review included studies published up to June 2013 addressing case-mix factors for 6 key diabetes indicators: 2 outcomes and 2 process indicators for glycated hemoglobin (A1C), low-density lipoprotein cholesterol, and blood pressure. Factors were categorized as demographic, diabetes-related, comorbidity, generic health, geographic, or care-seeking, and were evaluated on the rationale for inclusion in the adjustment models, as well as their impact on indicator scores and ranking. Thirteen studies were included, mainly addressing A1C value and measurement. Twenty-three different case-mix factors, mostly demographic and diabetes-related, were identified, and varied from 1 to 14 per adjustment model. Six studies provided selection motives for the inclusion of case-mix factors. Marital status and body mass index showed a significant impact on A1C value. For the other factors, either no or conflicting associations were reported, or too few studies (n ≤ 2) investigated this association. Scientific knowledge about the relative importance of case-mix factors for diabetes indicators is emerging, especially for demographic and diabetes-related factors and indicators on A1C, but is still limited. Because arbitrary adjustment potentially results in inaccurate quality information, meaningful stratification that demonstrates inequity in care might be a better guide, as it can be a driver for quality improvement.

  17. Educational Cost Analysis in Action: Case Studies for Planners -- II.

    Science.gov (United States)

    Coombs, Philip H.; Hallak, Jacques

    This document is the second in a series of three documents, which together contain 27 case studies on the uses of cost analysis in educational planning. The case studies are presented to help planners and administrators see how cost analysis can be used to improve the efficiency of their educational systems, or to get the best value existing…

  18. Educational Cost Analysis in Action: Case Studies for Planners -- III.

    Science.gov (United States)

    Coombs, Philip H.; Hallak, Jacques

    This document is the third in a series of three documents, which together contain 27 case studies on the uses of cost analysis in educational planning. The case studies have been presented to help planners and administrators see how cost analysis can be used to improve the efficiency of their educational systems, and to get the best value from…

  19. Educational Cost Analysis in Action: Case Studies for Planners -- I.

    Science.gov (United States)

    Coombs, Philip H.; Hallak, Jacques

    This document is the first in a series of three documents, which together contains 27 case studies on the uses of cost analysis in educational planning. The case studies have been presented to help planners and administrators see how cost analysis can be used to improve the efficiency of their educational systems, or how to get the best value from…

  20. Design Optimization of Mixed-Criticality Real-Time Applications on Cost-Constrained Partitioned Architectures

    DEFF Research Database (Denmark)

    Tamas-Selicean, Domitian; Pop, Paul

    2011-01-01

    In this paper we are interested to implement mixed-criticality hard real-time applications on a given heterogeneous distributed architecture. Applications have different criticality levels, captured by their Safety-Integrity Level (SIL), and are scheduled using static-cyclic scheduling. Mixed...... of different SILs can share a partition only if they are all elevated to the highest SIL among them. Such elevation leads to increased development costs.We are interested to determine (i) the mapping of tasks to processors, (ii) the assignment of tasks to partitions, (iii) the sequence and size of the time...

  1. Multi-Objective Sensitivity Analyses for Power Generation Mix: Malaysia Case Study

    Directory of Open Access Journals (Sweden)

    Siti Mariam Mohd Shokri

    2017-08-01

    Full Text Available This paper presents an optimization framework to determine long-term optimal generation mix for Malaysia Power Sector using Dynamic Programming (DP technique. Several new candidate units with a pre-defined MW capacity were included in the model for generation expansion planning from coal, natural gas, hydro and renewable energy (RE. Four objective cases were considered, 1 economic cost, 2 environmental, 3 reliability and 4 multi-objectives that combining the three cases. Results show that Malaysia optimum generation mix in 2030 for, 1 economic case is 48% from coal, 41% from gas, 3% from hydro and 8% from RE, 2 environmental case is 19% from coal, 58% from gas, 11% from hydro and 12% from RE, 3 for reliability case is 64% from coal, 32% from gas, 3% from hydro and 1% from RE and 4 multi-objective case is 49% from coal, 41% from gas, 7% from hydro and 3% from RE. The findings of this paper are the optimum generation mix for Malaysia from 2013 to 2030 which is less expensive, substantially reduce carbon emission and that less risky.  

  2. 42 CFR 412.84 - Payment for extraordinarily high-cost cases (cost outliers).

    Science.gov (United States)

    2010-10-01

    ... outliers). 412.84 Section 412.84 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices Payment for Outlier Cases § 412.84 Payment for extraordinarily high-cost cases...

  3. Utilization of Recycled Asphalt Concrete with Warm Mix Asphalt and Cost-Benefit Analysis

    OpenAIRE

    Julide Oner; Burak Sengoz

    2015-01-01

    The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP) is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA) technology provides not only the option of recycling asphalt pavement at a lower temperature than the tempe...

  4. Total Ownership Cost Reduction Case Study: AEGIS Radar Phase Shifters

    National Research Council Canada - National Science Library

    Bridger, Wray W; Ruiz, Mark D

    2006-01-01

    The goal of this research is to provide a case study that captures the production and design processes and program management solutions used to reduce total ownership costs of AEGIS Radar Phase Shifters...

  5. Cost of dengue outbreaks: literature review and country case studies

    Science.gov (United States)

    2013-01-01

    Background Dengue disease surveillance and vector surveillance are presumed to detect dengue outbreaks at an early stage and to save – through early response activities – resources, and reduce the social and economic impact of outbreaks on individuals, health systems and economies. The aim of this study is to unveil evidence on the cost of dengue outbreaks. Methods Economic evidence on dengue outbreaks was gathered by conducting a literature review and collecting information on the costs of recent dengue outbreaks in 4 countries: Peru, Dominican Republic, Vietnam, and Indonesia. The literature review distinguished between costs of dengue illness including cost of dengue outbreaks, cost of interventions and cost-effectiveness of interventions. Results Seventeen publications on cost of dengue showed a large range of costs from 0.2 Million US$ in Venezuela to 135.2 Million US$ in Brazil. However, these figures were not standardized to make them comparable. Furthermore, dengue outbreak costs are calculated differently across the publications, and cost of dengue illness is used interchangeably with cost of dengue outbreaks. Only one paper from Australia analysed the resources saved through active dengue surveillance. Costs of vector control interventions have been reported in 4 studies, indicating that the costs of such interventions are lower than those of actual outbreaks. Nine papers focussed on the cost-effectiveness of dengue vaccines or dengue vector control; they do not provide any direct information on cost of dengue outbreaks, but their modelling methodologies could guide future research on cost-effectiveness of national surveillance systems. The country case studies – conducted in very different geographic and health system settings - unveiled rough estimates for 2011 outbreak costs of: 12 million US$ in Vietnam, 6.75 million US$ in Indonesia, 4.5 million US$ in Peru and 2.8 million US$ in Dominican Republic (all in 2012 US$). The proportions of the

  6. Integration of water footprint accounting and costs for optimal pulp supply mix in paper industry

    DEFF Research Database (Denmark)

    Manzardo, Alessandro; Ren, Jingzheng; Piantella, Antonio

    2014-01-01

    studies have focused on these aspects, but there have been no previous reports on the integrated application of raw material water footprint accounting and costs in the definition of the optimal supply mix of chemical pulps from different countries. The current models that have been applied specifically...... that minimizes the water footprint accounting results and costs of chemical pulp, thereby facilitating the assessment of the water footprint by accounting for different chemical pulps purchased from various suppliers, with a focus on the efficiency of the production process. Water footprint accounting......Chemical pulp is one of the most important raw materials used in the paper industry. This material is known to make a significant contribution to the water footprint and cost of final paper products; therefore, chemical pulp is crucial in determining the competitiveness of final products'. Several...

  7. Relation between quality and production cost for pure biodiesel bases on the mixes of raw materials

    Science.gov (United States)

    Tsanaktsidis, C. G.; Spinthiropoulos, K. G.; Guliyev, Fariz; Dimitriou, D.; Euthaltsidou, K.; Tzilantonis, G. T.

    2016-08-01

    Nowadays biodiesel has become more attractive because it is made from renewable resources. The main ingredients of industrial biodiesel are rap oil, sun oil, fat acid, olive oil cooked. In this study we verify that, the proportion of these components sets the qualitative composition and energy efficiency of the final product. Essential we link the raw materials (rap oil, sun oil, fat acid, olive oil cooked) used in the manufacture of industrial biodiesel the proportion of mixes, with the variation of physicochemical properties of biodiesel produced. According to the quantitative analysis we notice that the physiochemical properties which alter the value for example humidity, acidity, while a large number of physicochemical properties do not change their value depending on the ratio of raw materials in each mixture. The analysis of these changes seems that the presence of fat acids is negative for the quality of the mixture. From the analysis of the cost of the final mixtures that lower cost is achieved in the mixture was 10 and the highest cost was in the mixture 3. Based on a study of the cost of the mixtures can determine a basic relation between the quality and the cost of the final product.

  8. Utilization of recycled asphalt concrete with warm mix asphalt and cost-benefit analysis.

    Science.gov (United States)

    Oner, Julide; Sengoz, Burak

    2015-01-01

    The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP) is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA) technology provides not only the option of recycling asphalt pavement at a lower temperature than the temperature maintained in hot mixtures but also encourages the utilization of RAP and therefore saves energy and money. This paper describes the feasibility of utilizing three different WMA additives (organic, chemical and water containing) at recommended contents with different percentages of RAP. The mechanical properties and cost-benefit analysis of WMA containing RAP have been performed and compared with WMA without RAP. The results indicated that, 30%, 10% and 20% can be accepted as an optimum RAP addition related to organic, chemical and water containing additives respectively and organic additive with 30% RAP content has an appreciable increase in tensile strength over the control mix. It was also concluded that the RAP with WMA technology is the ability to reduce final cost compared to HMA and WMA mixtures.

  9. Utilization of recycled asphalt concrete with warm mix asphalt and cost-benefit analysis.

    Directory of Open Access Journals (Sweden)

    Julide Oner

    Full Text Available The asphalt paving industries are faced with two major problems. These two important challenges are generated with an increase in demand for environmentally friendly paving mixtures and the problem of rapidly rising raw materials. Recycling of reclaimed asphalt pavement (RAP is a critical necessity to save precious aggregates and reduce the use of costly bitumen. Warm Mix Asphalt (WMA technology provides not only the option of recycling asphalt pavement at a lower temperature than the temperature maintained in hot mixtures but also encourages the utilization of RAP and therefore saves energy and money. This paper describes the feasibility of utilizing three different WMA additives (organic, chemical and water containing at recommended contents with different percentages of RAP. The mechanical properties and cost-benefit analysis of WMA containing RAP have been performed and compared with WMA without RAP. The results indicated that, 30%, 10% and 20% can be accepted as an optimum RAP addition related to organic, chemical and water containing additives respectively and organic additive with 30% RAP content has an appreciable increase in tensile strength over the control mix. It was also concluded that the RAP with WMA technology is the ability to reduce final cost compared to HMA and WMA mixtures.

  10. Case mix measures and diagnosis-related groups: opportunities and threats for inpatient dermatology.

    Science.gov (United States)

    Hensen, P; Fürstenberg, T; Luger, T A; Steinhoff, M; Roeder, N

    2005-09-01

    The changing healthcare environment world-wide is leading to extensive use of per case payment systems based on diagnosis-related groups (DRG). The aim of this study was to examine the impact of application of different DRG systems used in the German healthcare system. We retrospectively analysed 2334 clinical data sets of inpatients discharged from an academic dermatological inpatient unit in 2003. Data were regarded as providing high coding quality in compliance with the diagnosis and procedure classifications as well as coding standards. The application of the Australian AR-DRG version 4.1, the German G-DRG version 1.0, and the German G-DRG version 2004 was considered in detail. To evaluate more specific aspects, data were broken down into 11 groups based on the principle diagnosis. DRG cost weights and case mix index were used to compare coverage of inpatient dermatological services. Economic impacts were illustrated by case mix volumes and calculation of DRG payments. Case mix index results and the pending prospective revenues vary tremendously from the application of one or another of the DRG systems. The G-DRG version 2004 provides increased levels of case mix index that encourages, in particular, medical dermatology. The AR-DRG version 4.1 and the first German DRG version 1.0 appear to be less suitable to adequately cover inpatient dermatology. The G-DRG version 2004 has been greatly improved, probably due to proceeding calculation standards and DRG adjustments. The future of inpatient dermatology is subject to appropriate depiction of well-established treatment standards.

  11. A Versatile Mixed-Signal Pin Approach for Cost-Effective Test of Automotive ICs

    Institute of Scientific and Technical Information of China (English)

    Credence Systems Corporation

    2004-01-01

    @@ Integrated circuits (ICs) intended for increasingly sophisticated automotive applications bring unique test demands. Advanced ICs for applications such as highly integrated automatic braking system (ABS) and airbag controllers combine high voltage digital channels, significant VI demands and precise timing capability. Along with continued missioncritical reliability concerns, the trend toward higher voltage operation and increased device integration requires specialized test capabilities able to extend across the wide operating ranges found in automotive applications. Among these capabilities, automotive test requirements increasingly dictate a need for a cost-effective versatile mixed-signal pin electronics with very high data rates reaching up to 50MHz with a voltage swing of-2 V to +28 V.

  12. Eclectic/mixed approach to physiotherapy in post-stroke patients – case study

    Directory of Open Access Journals (Sweden)

    Emilia Mikołajewska

    2015-07-01

    Full Text Available The prevalence of stroke, and its associated costs, are going to rise with the aging population and changes in lifestyle in developing countries. Further research should better identify modifiable and non-modifiable determinants of poor outcomes in stroke survivors. Complex rehabilitation of post-stroke survivors still needs novel solutions. An eclectic/mixed approach to intervention, regarded as synthesis of the classical intervention methods, techniques, and tools, may be regarded as one of them, but it still needs more research. The aim of the article is to familiarise the aforementioned approach based on the presented case report and to investigate the extent to which available opportunities of an eclectic/mixed approach to physiotherapy is being exploited.

  13. Reducing of thermal power energy-intensive pro-cesses costs in the mixed fodders technology

    Directory of Open Access Journals (Sweden)

    L. I. Lytkina

    2016-01-01

    Full Text Available Methodological approach to the creation of energy-efficient processes with direct involvement in the produc-tion process of heat pump technology for the preparation of of energy resources in obtaining of mixed fodders of the given particle size distribution was formed. Completed experimental and analytical studies paved the way for the development of energy efficient technolo-gies of mixed fodders with a vapor compression connection (VCHP and steam ejector (SEHP heat pumps on the closed thermody-namic schemes. It was shown that the strategy of the operational management of process parameters in the allowable technological properties of the resulting mixed fodder production does not allow a compromise between the conflicting technical and economic param-eters and let the main technical contradiction between productivity and power consumption. The control problem becomes much more complicated when there is no practical possibility of a detailed description of thermal processes occurring in the closed thermodynamic recycles based on the phenomenological laws of thermodynamics considering a balance of material and energy flows in the technologi-cal system. There is a need for adaptive control systems based on the extreme characteristics of the controlled object. The adaptation effect is achieved by obtaining information about the processes occurring in the conditions of technological line of mixed fodders pro-duction equalized particle size distribution, which allows to generate a control signal for the extreme value of the objective function. The scheme of automatic optimization ensuring continuous monitoring of the minimum value of the specific heat energy costs is proposed. It provides optimal consumption of the starting loose mixed fodder and rational strain on the line equipment.

  14. Cost avoidance realized through transportation and disposal of Fernald mixed low-level waste

    Energy Technology Data Exchange (ETDEWEB)

    Sparks, A.K.; Dilday, D.R. [Fluor Daniel Environmental Restoration Management Corp., Fernald, OH (United States); Rast, D.M. [USDOE Fernald Field Office, OH (United States)

    1995-11-01

    Currently, Department of Energy (DOE) facilities are undergoing a transformation from shipping radiologically contaminated waste within the DOE structure for disposal to now include Mixed Low Level Waste (MLLW) shipments to a permitted commercial disposal facility (PCDF) final disposition. Implementing this change can be confusing and is perceived as being more difficult than it actually is. Lack of experience and disposal capacity, sometimes and/or confusing regulatory guidance, and expense of transportation and disposal of MLLW ar contributing factors to many DOE facilities opting to simply store their MLLW. Fernald Environmental Restoration Management Company (FERMCO) established itself as a leader i addressing MLLW transportation and disposal by being one of the first DOE facilities to ship mixed waste to a PCDF (Envirocare of Utah) for disposal. FERMCO`s proactive approach in establishing a MLLW Disposal Program produces long-term cost savings while generating interim mixed waste storage space to support FERMCO`s cleanup mission. FERMCO`s goal for all MLLW shipments was to develop a cost efficient system to accurately characterize, sample and analyze the waste, prepare containers and shipping paperwork, and achieve regulatory compliance while satisfying disposal facility waste acceptance criteria (WAC). This goal required the ability to evolve with the regulations, to address waste streams of varying matrices and contaminants, and to learn from each MLLW shipment campaign. These efforts have produced a successful MLLW Disposal Program at the Fernald Environmental Management Project (FEMP). FERMCO has a massed lessons learned from development of this fledgling program which may be applied complex-wide to ultimately save facilities time and money traditionally wasted by maintaining the status quo.

  15. Technology, safety and costs of decommissioning a reference small mixed oxide fuel fabrication plant. Volume 1. Main report

    Energy Technology Data Exchange (ETDEWEB)

    Jenkins, C. E.; Murphy, E. S.; Schneider, K J

    1979-01-01

    Detailed technology, safety and cost information are presented for the conceptual decommissioning of a reference small mixed oxide fuel fabrication plant. Alternate methods of decommissioning are described including immediate dismantlement, safe storage for a period of time followed by dismantlement and entombment. Safety analyses, both occupational and public, and cost evaluations were conducted for each mode.

  16. Renal mixed epithelial and stromal tumor: case report

    Directory of Open Access Journals (Sweden)

    Karla Lais Pêgas

    2015-02-01

    Full Text Available Mixed epithelial and stromal tumor (MEST represents a recently described biphasic kidney neoplasm, which predominantly affects perimenopausal females. The authors report the case of a young male patient with a MEST exhibiting positivity for estrogen and progesterone receptors. Computed tomography/magnetic resonance imaging (CT/MRI showed an expansive lesion affecting the right kidney. Grossly, a solid-cystic tumor was identified, which measured 5.7 × 3.5 × 2.4 cm. On microscopic examination, a biphasic tumor constituted by stromal and epithelial elements, without significant atypias, was identified. The stromal element was composed of spindle cells revealing positive immunoexpression for actin, desmin, vimentin, and estrogen receptors. The epithelial component exhibited a predominantly tubular pattern showing positive immunoreaction for cytokeratins. The diagnosis of MEST was then established.

  17. [A case of mixed adenoneuroendocrine carcinoma of the transverse colon].

    Science.gov (United States)

    Kusakabe, Jiro; Miki, Akira; Kobayashi, Hiroyuki; Uryuhara, Kenji; Hashida, Hiroki; Mizumoto, Masaki; Kaihara, Satoshi; Hosotani, Ryo; Yamashita, Daisuke

    2014-11-01

    A 7 1-year-old man presented to our hospital with constipation and abdominal pain. Computed tomography of the abdomen and colonoscopy revealed advanced cancer of the transverse colon. The biopsy specimen indicated a highly differentiated adenocarcinoma. The patient underwent extended right hemicolectomy with regional lymph node dissection. Pathological examination showed a neuroendocrine carcinoma (NEC) with concurrent adenocarcinoma of the transverse colon and regional lymph node metastases of the NEC and adenocarcinoma. The histopathological examination confirmed a diagnosis of mixed adenoneuroendocrine carcinoma (MANEC) in accordance with the 2010 WHO Classification of Tumors of the Digestive System. Liver and lung metastases were identified 8 months after the surgery. We administered chemotherapy including 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX) plus bevacizumab, with limited therapeutic effect, as the disease progressed despite treatment. The patient chose best supportive care 13 months after the surgery. Several studies have reported that most patients with adenoendocrine cell carcinoma, including MANEC, experience relapse within 1 year after surgery, and few patients remain disease-free for long periods after surgery. The optimal strategy for the management of MANEC is variable owing to its rarity; only 2 cases of MANEC in the colon, including the present case, have been reported in Japan. It is thus important to gather more evidence on this disease and its management.

  18. [Case management. The nursing business of care or cost].

    Science.gov (United States)

    Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L

    1992-01-01

    Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management.

  19. Complexity of case mix in a regional allergy service

    Directory of Open Access Journals (Sweden)

    Kaminski Edward R

    2012-02-01

    Full Text Available Abstract Background Currently in the United Kingdom (UK, there is a mismatch between limited financial resources and the large proportion of patients with suspected allergies actually being referred to specialist allergy clinics. To better understand the case mix of patients being referred, we audited referrals to a regional allergy service over an 8 year period. The main source of data was consultant letters to General Practitioners (GP summarising the diagnosis of patients, archived from January 2002 to September 2009. Letters were reviewed, extracting the clinic date, doctor seen, gender, date of birth, postcode, GP, and diagnoses. Diagnoses were classified into seven groups and illustrative cases for each group noted. Findings Data from 2,028 new referrals with suspected allergy were analysed. The largest group of patients (43% were diagnosed with a type I hypersensitivity. The other diagnostic groups were chronic idiopathic (spontaneous urticaria (35%, suspected type I hypersensitivity but no allergen identified (8%, idiopathic (spontaneous angioedema (8%, physical urticaria (2.5%, non-allergic symptoms (1.6%, type IV hypersensitivity (0.8% and ACE inhibitor sensitivity (0.5%. Two thirds of patients seen were female with a higher percentage of female patients in the non type-I hypersensitivity group (71% than the type 1 hypersensitivity (66% (χ2 = 5.1, 1df, p = 0.024. The type 1 hypersensitivity patients were younger than other patients (38 Vs 46 years, t = -10.8, p Conclusions This study highlights the complexity of specialist allergy practice and the large proportion of patients referred with non-type I hypersensitivities, chronic idiopathic (spontaneous urticaria being by far the largest group. Such information is critical to inform commissioning decisions, define referral pathways and in primary care education.

  20. A Case Study of a Mixed Methods Study Engaged in Integrated Data Analysis

    Science.gov (United States)

    Schiazza, Daniela Marie

    2013-01-01

    The nascent field of mixed methods research has yet to develop a cohesive framework of guidelines and procedures for mixed methods data analysis (Greene, 2008). To support the field's development of analytical frameworks, this case study reflects on the development and implementation of a mixed methods study engaged in integrated data analysis.…

  1. A Case Study of a Mixed Methods Study Engaged in Integrated Data Analysis

    Science.gov (United States)

    Schiazza, Daniela Marie

    2013-01-01

    The nascent field of mixed methods research has yet to develop a cohesive framework of guidelines and procedures for mixed methods data analysis (Greene, 2008). To support the field's development of analytical frameworks, this case study reflects on the development and implementation of a mixed methods study engaged in integrated data analysis.…

  2. Tracing the missing link between nursing workload and case mix groups: a validation study.

    Science.gov (United States)

    Halpine, S; Maloney, S

    1993-01-01

    This paper reports on the creation of a nursing workload data base of over 40,000 inpatient records by the Hospital Medical Records Institute (HMRI). During the 1989-90 fiscal year, five Ontario hospitals (four teaching, one community) reported total hours of nursing on the HMRI abstract along with standard clinical and demographic information. The accuracy of nursing workload data varied across hospitals and seemed to reflect differences in how data collection was implemented. When the data base was grouped by Case Mix Groups (CMGs), analysis demonstrated that patterns of resource utilization in nursing workload and length of stay were similar across CMGs. Results of this analysis indicate that the nursing workload component of the Resource Intensity Weight may be useful for estimating a hospital's nursing costs by CMG.

  3. Mixed tumour of schwannoma and meningioma in a patient with neurofibromatosis-2 : a case report.

    Directory of Open Access Journals (Sweden)

    Elizabeth J

    2001-10-01

    Full Text Available The co-existence of schwannoma and meningioma as a mixed intracranial tumour is uncommon and so far only eight cases have been published in the literature. Because of rarity, we report a unique case of mixed tumour having schwann cell and meningeal components, in a patient with neurofibromatosis type -2 (NF-2. The possible mechanisms for the occurrence of these mixed tumours are discussed.

  4. Single-Case Designs and Qualitative Methods: Applying a Mixed Methods Research Perspective

    Science.gov (United States)

    Hitchcock, John H.; Nastasi, Bonnie K.; Summerville, Meredith

    2010-01-01

    The purpose of this conceptual paper is to describe a design that mixes single-case (sometimes referred to as single-subject) and qualitative methods, hereafter referred to as a single-case mixed methods design (SCD-MM). Minimal attention has been given to the topic of applying qualitative methods to SCD work in the literature. These two…

  5. Single-Case Designs and Qualitative Methods: Applying a Mixed Methods Research Perspective

    Science.gov (United States)

    Hitchcock, John H.; Nastasi, Bonnie K.; Summerville, Meredith

    2010-01-01

    The purpose of this conceptual paper is to describe a design that mixes single-case (sometimes referred to as single-subject) and qualitative methods, hereafter referred to as a single-case mixed methods design (SCD-MM). Minimal attention has been given to the topic of applying qualitative methods to SCD work in the literature. These two…

  6. Effectiveness and cost effectiveness of expanding harm reduction and antiretroviral therapy in a mixed HIV epidemic: a modeling analysis for Ukraine.

    Directory of Open Access Journals (Sweden)

    Sabina S Alistar

    2011-03-01

    Full Text Available Injection drug use (IDU and heterosexual virus transmission both contribute to the growing mixed HIV epidemics in Eastern Europe and Central Asia. In Ukraine-chosen in this study as a representative country-IDU-related risk behaviors cause half of new infections, but few injection drug users (IDUs receive methadone substitution therapy. Only 10% of eligible individuals receive antiretroviral therapy (ART. The appropriate resource allocation between these programs has not been studied. We estimated the effectiveness and cost-effectiveness of strategies for expanding methadone substitution therapy programs and ART in mixed HIV epidemics, using Ukraine as a case study.We developed a dynamic compartmental model of the HIV epidemic in a population of non-IDUs, IDUs using opiates, and IDUs on methadone substitution therapy, stratified by HIV status, and populated it with data from the Ukraine. We considered interventions expanding methadone substitution therapy, increasing access to ART, or both. We measured health care costs, quality-adjusted life years (QALYs, HIV prevalence, infections averted, and incremental cost-effectiveness. Without incremental interventions, HIV prevalence reached 67.2% (IDUs and 0.88% (non-IDUs after 20 years. Offering methadone substitution therapy to 25% of IDUs reduced prevalence most effectively (to 53.1% IDUs, 0.80% non-IDUs, and was most cost-effective, averting 4,700 infections and adding 76,000 QALYs compared with no intervention at US$530/QALY gained. Expanding both ART (80% coverage of those eligible for ART according to WHO criteria and methadone substitution therapy (25% coverage was the next most cost-effective strategy, adding 105,000 QALYs at US$1,120/QALY gained versus the methadone substitution therapy-only strategy and averting 8,300 infections versus no intervention. Expanding only ART (80% coverage added 38,000 QALYs at US$2,240/QALY gained versus the methadone substitution therapy-only strategy, and

  7. Clozapine-induced severe mixed hyperlipidemia: a case report.

    LENUS (Irish Health Repository)

    Ahmed, Mohamed

    2009-01-01

    To highlight the association between the use of clozapine and the early development of severe mixed hyperlipidemia, a condition that substantially increases the risk of cardiovascular events and other medical complications.

  8. Mixed

    Directory of Open Access Journals (Sweden)

    Pau Baya

    2011-05-01

    Full Text Available Remenat (Catalan (Mixed, "revoltillo" (Scrambled in Spanish, is a dish which, in Catalunya, consists of a beaten egg cooked with vegetables or other ingredients, normally prawns or asparagus. It is delicious. Scrambled refers to the action of mixing the beaten egg with other ingredients in a pan, normally using a wooden spoon Thought is frequently an amalgam of past ideas put through a spinner and rhythmically shaken around like a cocktail until a uniform and dense paste is made. This malleable product, rather like a cake mixture can be deformed pulling it out, rolling it around, adapting its shape to the commands of one’s hands or the tool which is being used on it. In the piece Mixed, the contortion of the wood seeks to reproduce the plasticity of this slow heavy movement. Each piece lays itself on the next piece consecutively like a tongue of incandescent lava slowly advancing but with unstoppable inertia.

  9. Incorporation of Fixed Installation Costs into Optimization of Groundwater Remediation with a New Efficient Surrogate Nonlinear Mixed Integer Optimization Algorithm

    Science.gov (United States)

    Shoemaker, Christine; Wan, Ying

    2016-04-01

    Optimization of nonlinear water resources management issues which have a mixture of fixed (e.g. construction cost for a well) and variable (e.g. cost per gallon of water pumped) costs has been not well addressed because prior algorithms for the resulting nonlinear mixed integer problems have required many groundwater simulations (with different configurations of decision variable), especially when the solution space is multimodal. In particular heuristic methods like genetic algorithms have often been used in the water resources area, but they require so many groundwater simulations that only small systems have been solved. Hence there is a need to have a method that reduces the number of expensive groundwater simulations. A recently published algorithm for nonlinear mixed integer programming using surrogates was shown in this study to greatly reduce the computational effort for obtaining accurate answers to problems involving fixed costs for well construction as well as variable costs for pumping because of a substantial reduction in the number of groundwater simulations required to obtain an accurate answer. Results are presented for a US EPA hazardous waste site. The nonlinear mixed integer surrogate algorithm is general and can be used on other problems arising in hydrology with open source codes in Matlab and python ("pySOT" in Bitbucket).

  10. Analysis of fluid mixing characteristics in reactor vessel downcomer using Theofanous and Wallis` mixing model. (DVI Case)

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Bong Hyun; Kim, Hwan Yeol; Kang, Hyung Seok; Bae, Yoon Young

    1997-05-01

    Direct injection of emergency core cooling water into the reactor vessel downcomer annulus (DVI) is an unique feature of the four-train safety injection system of Korean Next Generation Reactor(KNGR). In this study, in order to evaluate the fluid mixing characteristics of the injected water for DVI case, we have suggested for application to DVI, Theofanous` regional mixing model and Wallis` experiments of flow regimes for injection water to the annulus. Theofanous`model was developed as a fluid mixing model in reactor vessel downcomer for the case of Cold Leg Injection(CLI). We have established a procedure for calculating fluid mixing temperature, calculated the mixing temperature for SBLOCA and MSLB, and compared them to those of CLI. In general, the fluid temperatures across the reactor vessel beltline are higher than 110 deg F, the RT{sub NDT} of EOL for reactor vessel material, and the values are within the acceptable limits of PTS concern. (author). 6 tabs., 21 figs., 11 refs.

  11. [Costs of early retirement--the case of schizophrenia].

    Science.gov (United States)

    Clouth, Johannes

    2004-11-01

    Schizophrenia is a severe psychic disorder that occurs at young age and often leads to a work disability. The disease not only induces direct costs in the health care system but also indirect costs that show up in the social security system. In this study, we apply statistics from the social security administration on early retirement due to disability. Over 6000-males and females per year retire with the diagnosis schizophrenia (classified as 295, ICD-9). The average retirement age is 39 for males and 42 for females. Schizophrenia is the most important single reason for early retirement before age 40. Of all male cases of disability retirement under the age of 40, 14.7 % are due to schizophrenia. The present discounted value of pensions paid out before the standard retirement age of 65 is 215 000 Euro for an average male. Moreover, the revenue loss in income taxes and payroll contributions amounts to 345 000 Euro. In the year 2000, a total of 125 000 persons under the age of 65, who originally entered retirement with the diagnosis schizophrenia, are estimated to be receiving a pension. The corresponding annual expenditures of the social security system reach 1.3 Billion Euro; the revenue loss (pay-roll plus income taxes) reaches 2 Billion Euro. Since only two thirds of the working age population is covered by the social security system, the costs of early retirement due to schizophrenia are underestimated by a factor of at least one third.

  12. Econometric Analysis of Marketing Costs: A Case Study

    NARCIS (Netherlands)

    Kuwornu, J.K.M.; Abboah, R.; Amegashie, D.P.K.; Kuiper, W.E.

    2009-01-01

    This study analyzes the marketing costs of a pineapple producing and export firm (Bomart Farms) in Ghana. Con­ sistent with the existing literature, we categorize marketing costs into assembling, processing, and distribution costs. The assembling cost comprises of cost of crating and loading fresh

  13. Econometric Analysis of Marketing Costs: A Case Study

    NARCIS (Netherlands)

    Kuwornu, J.K.M.; Abboah, R.; Amegashie, D.P.K.; Kuiper, W.E.

    2009-01-01

    This study analyzes the marketing costs of a pineapple producing and export firm (Bomart Farms) in Ghana. Con­ sistent with the existing literature, we categorize marketing costs into assembling, processing, and distribution costs. The assembling cost comprises of cost of crating and loading fresh f

  14. Econometric Analysis of Marketing Costs: A Case Study

    NARCIS (Netherlands)

    Kuwornu, J.K.M.; Abboah, R.; Amegashie, D.P.K.; Kuiper, W.E.

    2009-01-01

    This study analyzes the marketing costs of a pineapple producing and export firm (Bomart Farms) in Ghana. Con­ sistent with the existing literature, we categorize marketing costs into assembling, processing, and distribution costs. The assembling cost comprises of cost of crating and loading fresh f

  15. A new low-cost method of reclaiming mixed foundry waste sand based on wet-thermal composite reclamation

    Institute of Scientific and Technical Information of China (English)

    Fan Zitian; Liu Fuchu; Long Wei; Li Guona

    2014-01-01

    A lot of mixed clay-resin waste sand from large-scale iron foundries is discharged every day; so mixed waste sand reclamation in low cost and high quality has a great realistic significance. In the study to investigate the possibility of reusing two types of waste foundry sands, resin bonded sand and clay bonded sand which came from a Chinese casting factory, a new low-cost reclamation method of the mixed foundry waste sand based on the wet-thermal composite reclamation was proposed. The waste resin bonded sand was first reclaimed by a thermal method and the waste clay bonded sand was reclaimed by a wet method. Then, hot thermal reclaimed sand and the dehydrated wet reclaimed sand were mixed in certain proportions so that the hot thermal reclaimed sand dried the wet reclaimed sand leaving some water. The thermal reclamation efficiency of the waste resin bonded sand was researched at different heat levels. The optimized wet reclamation process of the waste clay bonded sand was achieved by investigating the effects of wet reclamation times, sand-water ratio and pH value on the reclaimed sand characteristics. The composite reclamation cost also was calculated. The research results showed that the properties of the mixed reclaimed sand can satisfy the application requirements of foundries; in which the temperature of the thermal reclamation waste resin bonded sand needs to be about 800 ºC, the number of cycles of wet reclamation waste clay bonded sand should reach four to five, the optimal sand-water ratio of wet reclamation is around 1:1.5, and the pH value should be adjusted by adding acid. The mass ratio of hot thermal reclaimed sand to dehydrated wet reclaimed sand is about 1:2.5, and the composite reclaimed sand cost is around 100 yuan RMB per ton.

  16. A new low-cost method of reclaiming mixed foundry waste sand based on wet-thermal composite reclamation

    Directory of Open Access Journals (Sweden)

    Fan Zitian

    2014-09-01

    Full Text Available A lot of mixed clay-resin waste sand from large-scale iron foundries is discharged every day; so mixed waste sand reclamation in low cost and high quality has a great realistic significance. In the study to investigate the possibility of reusing two types of waste foundry sands, resin bonded sand and clay bonded sand which came from a Chinese casting factory, a new low-cost reclamation method of the mixed foundry waste sand based on the wet-thermal composite reclamation was proposed. The waste resin bonded sand was first reclaimed by a thermal method and the waste clay bonded sand was reclaimed by a wet method. Then, hot thermal reclaimed sand and the dehydrated wet reclaimed sand were mixed in certain proportions so that the hot thermal reclaimed sand dried the wet reclaimed sand leaving some water. The thermal reclamation efficiency of the waste resin bonded sand was researched at different heat levels. The optimized wet reclamation process of the waste clay bonded sand was achieved by investigating the effects of wet reclamation times, sand-water ratio and pH value on the reclaimed sand characteristics. The composite reclamation cost also was calculated. The research results showed that the properties of the mixed reclaimed sand can satisfy the application requirements of foundries; in which the temperature of the thermal reclamation waste resin bonded sand needs to be about 800 篊, the number of cycles of wet reclamation waste clay bonded sand should reach four to five, the optimal sand-water ratio of wet reclamation is around 1:1.5, and the pH value should be adjusted by adding acid. The mass ratio of hot thermal reclaimed sand to dehydrated wet reclaimed sand is about 1:2.5, and the composite reclaimed sand cost is around 100 yuan RMB per ton.

  17. 49 CFR 1111.8 - Procedural schedule in stand-alone cost cases.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 8 2010-10-01 2010-10-01 false Procedural schedule in stand-alone cost cases... § 1111.8 Procedural schedule in stand-alone cost cases. (a) Procedural schedule. Absent a specific order by the Board, the following general procedural schedule will apply in stand-alone cost cases: Day...

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

    Science.gov (United States)

    Zhang, Li; Domröse, Sascha; Mahnken, Andreas

    2015-10-01

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

  19. The case for mixed dark matter from sterile neutrinos

    Science.gov (United States)

    Lello, Louis; Boyanovsky, Daniel

    2016-06-01

    Sterile neutrinos are SU(2) singlets that mix with active neutrinos via a mass matrix, its diagonalization leads to mass eigenstates that couple via standard model vertices. We study the cosmological production of heavy neutrinos via standard model charged and neutral current vertices under a minimal set of assumptions: i) the mass basis contains a hierarchy of heavy neutrinos, ii) these have very small mixing angles with the active (flavor) neutrinos, iii) standard model particles, including light (active-like) neutrinos are in thermal equilibrium. If kinematically allowed, the same weak interaction processes that produce active-like neutrinos also produce the heavier species. We introduce the quantum kinetic equations that describe their production, freeze out and decay and discuss the various processes that lead to their production in a wide range of temperatures assessing their feasibility as dark matter candidates. The final distribution function at freeze-out is a mixture of the result of the various production processes. We identify processes in which finite temperature collective excitations may lead to the production of the heavy species. As a specific example, we consider the production of heavy neutrinos in the mass range Mh lesssim 140 MeV from pion decay shortly after the QCD crossover including finite temperature corrections to the pion form factors and mass. We consider the different decay channels that allow for the production of heavy neutrinos showing that their frozen distribution functions exhibit effects from ``kinematic entanglement'' and argue for their viability as mixed dark matter candidates. We discuss abundance, phase space density and stability constraints and argue that heavy neutrinos with lifetime τ> 1/H0 freeze out of local thermal equilibrium, and conjecture that those with lifetimes τ ll 1/H0 may undergo cascade decay into lighter DM candidates and/or inject non-LTE neutrinos into the cosmic neutrino background. We provide a

  20. Case report on vertebral artery dissection in mixed martial arts.

    Science.gov (United States)

    Slowey, Michael; Maw, Graeme; Furyk, Jeremy

    2012-04-01

    A 41-year-old man presented to the ED with severe vertigo 2 days after a grappling injury while training in mixed martial arts. Imaging revealed a cerebellar infarct with complete occlusion of the right vertebral artery secondary to dissection. Management options are discussed as is the ongoing controversy regarding the safety of the sport. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  1. A Versatile Mixed-Signal Pin Approach for Cost-Effective Test of Automotive ICs

    Institute of Scientific and Technical Information of China (English)

    Credence Systems Corporation

    2004-01-01

    @@ (上接第9期51页) Figure 3:3 different pins types which cover a wide range of requirements: - DPIN: The digital mixed signal pin for high speed digital requirements - VPIN digital mixed-signal pin with high voltage digital test capability. With the 30 V swing and 50 MHz data rate the pin fits excellent for automotive requirements.

  2. The RoboCup Mixed Reality League - A Case Study

    Science.gov (United States)

    Gerndt, Reinhard; Bohnen, Matthias; da Silva Guerra, Rodrigo; Asada, Minoru

    In typical mixed reality systems there is only a one-way interaction from real to virtual. A human user or the physics of a real object may influence the behavior of virtual objects, but real objects usually cannot be influenced by the virtual world. By introducing real robots into the mixed reality system, we allow a true two-way interaction between virtual and real worlds. Our system has been used since 2007 to implement the RoboCup mixed reality soccer games and other applications for research and edutainment. Our framework system is freely programmable to generate any virtual environment, which may then be further supplemented with virtual and real objects. The system allows for control of any real object based on differential drive robots. The robots may be adapted for different applications, e.g., with markers for identification or with covers to change shape and appearance. They may also be “equipped” with virtual tools. In this chapter we present the hardware and software architecture of our system and some applications. The authors believe this can be seen as a first implementation of Ivan Sutherland’s 1965 idea of the ultimate display: “The ultimate display would, of course, be a room within which the computer can control the existence of matter …” (Sutherland, 1965, Proceedings of IFIPS Congress 2:506-508).

  3. Effectiveness and cost effectiveness of oral pre-exposure prophylaxis in a portfolio of prevention programs for injection drug users in mixed HIV epidemics.

    Directory of Open Access Journals (Sweden)

    Sabina S Alistar

    Full Text Available BACKGROUND: Pre-exposure prophylaxis with oral antiretroviral treatment (oral PrEP for HIV-uninfected injection drug users (IDUs is potentially useful in controlling HIV epidemics with a significant injection drug use component. We estimated the effectiveness and cost effectiveness of strategies for using oral PrEP in various combinations with methadone maintenance treatment (MMT and antiretroviral treatment (ART in Ukraine, a representative case for mixed HIV epidemics. METHODS AND FINDINGS: We developed a dynamic compartmental model of the HIV epidemic in a population of non-IDUs, IDUs who inject opiates, and IDUs in MMT, adding an oral PrEP program (tenofovir/emtricitabine, 49% susceptibility reduction for uninfected IDUs. We analyzed intervention portfolios consisting of oral PrEP (25% or 50% of uninfected IDUs, MMT (25% of IDUs, and ART (80% of all eligible patients. We measured health care costs, quality-adjusted life years (QALYs, HIV prevalence, HIV infections averted, and incremental cost effectiveness. A combination of PrEP for 50% of IDUs and MMT lowered HIV prevalence the most in both IDUs and the general population. ART combined with MMT and PrEP (50% access averted the most infections (14,267. For a PrEP cost of $950, the most cost-effective strategy was MMT, at $520/QALY gained versus no intervention. The next most cost-effective strategy consisted of MMT and ART, costing $1,000/QALY gained compared to MMT alone. Further adding PrEP (25% access was also cost effective by World Health Organization standards, at $1,700/QALY gained. PrEP alone became as cost effective as MMT at a cost of $650, and cost saving at $370 or less. CONCLUSIONS: Oral PrEP for IDUs can be part of an effective and cost-effective strategy to control HIV in regions where injection drug use is a significant driver of the epidemic. Where budgets are limited, focusing on MMT and ART access should be the priority, unless PrEP has low cost.

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

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Li; Mahnken, Andreas [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic and Interventional Radiology, Baldinger Strasse, Marburg (Germany); Domroese, Sascha [University Hospital Giessen and Marburg, Philipps University of Marburg, Division of Controlling, Baldinger Strasse, Marburg (Germany)

    2015-10-15

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

  5. Development Phase Cost Drivers for Production Costs: The Case of Tracked Vehicles

    OpenAIRE

    Boger, Dan C.; Malcolm, David S.

    1993-01-01

    Approved for public release; distribution is unlimited. There are two different approaches, the disjoint and sequential models, which attempt to account for differences between development unit cost and production unit cost. The disjoint model uses a production cost improvement curve that is physically separate from the development cost improvement curve. For the sequential model, however, the first unit cost of production units directly follows the last development unit due to a carryover...

  6. Activity Based Costing and Product Pricing Decision: the Nigerian Case

    OpenAIRE

    Ebipanipre Gabriel Mieseigha

    2014-01-01

    This paper examined activity based costing and product pricing decisions in Nigeria so as to ascertain whether activity based costing have the ability to enhance profitability and control cost of manufacturing firms. Towards this end, a multiple correlation and regression estimation technique was used in analyzing the data obtained in the study. The study found that activity based costing affects product costing and pricing decision. In addition, the results showed that improved profitability...

  7. Omohyoid Muscle Syndrome in a Mixed Martial Arts Athlete: A Case Report.

    Science.gov (United States)

    Lee, Alexander D; Yu, Alexander; Young, Shayne B; Battaglia, Patrick J; Ho, C John

    2015-01-01

    Omohyoid muscle syndrome is a rare cause of an X-shaped bulging lateral neck mass that occurs on swallowing. This is a diagnostic case report of a 22-year-old mixed martial arts athlete who acquired this condition.

  8. Possibilities of implementing modern philosophy of cost accounting: The case study of costs in tourism

    Directory of Open Access Journals (Sweden)

    Milenković Zoran

    2015-01-01

    Full Text Available Efficient cost management is one of the key tasks in modern management, primarily because of causal connection of costs, profitability and competitive advantage on the market. As a market-based concept, Target Costing represents modern accounting philosophy of cost accounting and profit planning. In modern business, efficient cost planning and management is provided by accounting information system as an integrated accounting and information solution which supplies enterprises with accounting data processing necessary for making business decisions related to the efficient management in accordance with the declared mission and goals of an enterprise. Basic information support in the process of planning and cost management is carried out by the cost accounting module which is a very important part of the accounting information system in every enterprise. The cost monitoring is provided according to the type, place and bearer within the cost accounting module as a segment of an integral accounting information system.

  9. Three case studies involving Leptospira interrogans serovar pomona infection in mixed farming units : case report

    Directory of Open Access Journals (Sweden)

    B. Gummow

    1999-07-01

    Full Text Available Three case studies involving Leptospira interrogans serovar pomona outbreaks within mixed farming systems in South Africa are described. On 2 farms, pigs constituted the main enterprise with cattle and sheep of secondary importance. On each of these 2 farms, abortion due to L. pomona in sows was confirmed by culture, and antibody titres to pomona were detected in cattle, sheep, horses and dogs. On the 3rd farm, a piggery was ofsecondary importance to cattle farming. Abortion and death in cows occurred on this farmand serology showed titres to various serovars, including pomona. L. pomona was also isolated from bovine urine, an aborted bovine foetus and kidneys from slaughtered pigs. This particular case study was regarded as clinically atypical in that adult Jersey cattle died of acute leptospirosis in a semiarid region of South Africa. In all 3 case studies, the poor management of pig effluent and of the drinking water and its sources played a pivotal role in the transmission of the disease. Inadequate vaccination of animals against Leptospira and poor record-keeping within the secondary farming enterprises were also contributing factors to the spread of leptospirosis.

  10. Exposure to selected fragrance materials. A case study of fragrance-mix-positive eczema patients

    DEFF Research Database (Denmark)

    Johansen, J D; Rastogi, Suresh Chandra; Menné, T

    1996-01-01

    The aim of the present study was to assess exposure to constituents of the fragrance mix from cosmetic products used by fragrance-mix-positive eczema patients. 23 products, which had either given a positive patch and/or use test in a total of 11 fragrance-mix-positive patients, were analyzed....... In all cases, the use of these cosmetics completely or partly explained present or past episodes of eczema. Between 1 to 6 constituents of the fragrance mix were found in 22 out of 23 products. The cosmetics of all the patients sensitive to hydroxycitronellal, eugenol, cinnamic alcohol and alpha....... It is concluded that exposure to constituents of the fragrance mix is common in fragrance-allergic patients with cosmetic eczema, and that the fragrance mix is a good reflection of actual exposure....

  11. A framework for assessing cost management system changes: the case of activity-based costing implementation at food industry

    Directory of Open Access Journals (Sweden)

    Tayebeh Faraji

    2015-04-01

    Full Text Available An opportunity to investigate the technical and organizational effect of management accounting system changes has appeared with companies' adoption of activity-based costing (ABC. This paper presents an empirical investigation to study the effects of ABC system for case study from food industry in Iran. From this case, the paper develops a framework for assessing ABC implementation and hypotheses about factors that influence implementation. The study detects five cost centers and for each cost center, it determines different cost drivers. The results of our survey has detected that implementation of ABC system not only helps precise allocation of overhead costs but also helps internal management companies for better planning and control of production, making better decisions for company's profits.

  12. Molecular Analysis of Mixed Endometrial Carcinomas Shows Clonality in Most Cases.

    Science.gov (United States)

    Köbel, Martin; Meng, Bo; Hoang, Lien N; Almadani, Noorah; Li, Xiaodong; Soslow, Robert A; Gilks, C Blake; Lee, Cheng-Han

    2016-02-01

    Mixed endometrial carcinoma refers to a tumor that comprises 2 or more distinct histotypes. We studied 18 mixed-type endometrial carcinomas-11 mixed serous and low-grade endometrioid carcinomas (SC/EC), 5 mixed clear cell and low-grade ECs (CCC/EC), and 2 mixed CCC and SCs (CCC/SC), using targeted next-generation sequencing and immunohistochemistry to compare the molecular profiles of the different histotypes present in each case. In 16 of 18 cases there was molecular evidence that both components shared a clonal origin. Eight cases (6 EC/SC, 1 EC/CCC, and 1 SC/CCC) showed an SC molecular profile that was the same in both components. Five cases (3 CCC/EC and 2 SC/EC) showed a shared endometrioid molecular profile and identical mismatch-repair protein deficiency in both components. A single SC/EC case harbored the same POLE exonuclease domain mutation in both components. One SC/CCC and 1 EC/CCC case showed both shared and unique molecular features in the 2 histotype components, suggesting early molecular divergence from a common clonal origin. In 2 cases, there were no shared molecular features, and these appear to be biologically unrelated synchronous tumors. Overall, these results show that the different histologic components in mixed endometrial carcinomas typically share the same molecular aberrations. Mixed endometrial carcinomas most commonly occur through morphologic mimicry, whereby tumors with serous-type molecular profile show morphologic features of EC or CCC, or through underlying deficiency in DNA nucleotide repair, with resulting rapid accrual of mutations and intratumoral phenotypic heterogeneity. Less commonly, mixed endometrial carcinomas are the result of early molecular divergence from a common progenitor clone or are synchronous biologically unrelated tumors (collision tumors).

  13. Integrated model for assessing the cost and CO2 emission (IMACC) for sustainable structural design in ready-mix concrete.

    Science.gov (United States)

    Hong, Taehoon; Ji, Changyoon; Park, Hyoseon

    2012-07-30

    Cost has traditionally been considered the most important factor in the decision-making process. Recently, along with the consistent interest in environmental problems, environmental impact has also become a key factor. Accordingly, there is a need to develop a method that simultaneously reflects the cost and environmental impact in the decision-making process. This study proposed an integrated model for assessing the cost and CO(2) emission (IMACC) at the same time. IMACC is a model that assesses the cost and CO(2) emission of the various structural-design alternatives proposed in the structural-design process. To develop the IMACC, a standard on assessing the cost and CO(2) emission generated in the construction stage was proposed, along with the CO(2) emission factors in the structural materials, based on such materials' strengths. Moreover, using the economic and environmental scores that signify the cost and CO(2) emission reduction ratios, respectively, a method of selecting the best design alternative was proposed. To verify the applicability of IMACC, practical application was carried out. Structural designs were assessed, each of which used 21, 24, 27, and 30 MPa ready-mix concrete (RMC). The use of IMACC makes it easy to verify what the best design is. Results show the one that used 27 MPa RMC was the best design. Therefore, the proposed IMACC can be used as a tool for supporting the decision-making process in selecting the best design alternative.

  14. The d-Prime directive: Assessing costs and benefits in recognition by dissociating mixed-list false alarm rates.

    Science.gov (United States)

    Forrin, Noah D; Groot, Brianna; MacLeod, Colin M

    2016-07-01

    It can be difficult to judge the effectiveness of encoding techniques in a within-subject design. Consider the production effect-the finding that words read aloud are better remembered than words read silently. In the absence of a baseline, a within-subject production effect in a mixed study list could reflect a benefit of reading aloud, a cost of reading silently, or both. To help interpret within-subject data, memory researchers have compared within-subject and between-subjects designs, with the between-subjects (i.e., pure list) conditions serving as baselines against which the within-subject (i.e., mixed-list) conditions are compared. In the present article, the authors highlight a shortcoming of using this comparison to assess costs and benefits in recognition. Unlike between-subjects experiments where separate false alarm rates are obtained for each condition, the typical within-subject experiment yields a collapsed false alarm rate, which, the authors argue, can potentially bias calculations of memory discrimination (d'). Across 3 experiments that used production as the encoding manipulation, they used a typical mixed-list versus pure-list design (Experiment 1) and then made modifications to this design (Experiments 2 and 3) that yielded separate mixed-list false alarm rates. The results of the latter 2 experiments demonstrated that words that are read aloud in a mixed list have an overall memorial benefit over words that are read aloud in a pure list-both in terms of increased hits and reduced false alarms. The authors frame these results in terms of the distinctiveness heuristic. (PsycINFO Database Record

  15. Stochastic nonlinear mixed effects: a metformin case study.

    Science.gov (United States)

    Matzuka, Brett; Chittenden, Jason; Monteleone, Jonathan; Tran, Hien

    2016-02-01

    In nonlinear mixed effect (NLME) modeling, the intra-individual variability is a collection of errors due to assay sensitivity, dosing, sampling, as well as model misspecification. Utilizing stochastic differential equations (SDE) within the NLME framework allows the decoupling of the measurement errors from the model misspecification. This leads the SDE approach to be a novel tool for model refinement. Using Metformin clinical pharmacokinetic (PK) data, the process of model development through the use of SDEs in population PK modeling was done to study the dynamics of absorption rate. A base model was constructed and then refined by using the system noise terms of the SDEs to track model parameters and model misspecification. This provides the unique advantage of making no underlying assumptions about the structural model for the absorption process while quantifying insufficiencies in the current model. This article focuses on implementing the extended Kalman filter and unscented Kalman filter in an NLME framework for parameter estimation and model development, comparing the methodologies, and illustrating their challenges and utility. The Kalman filter algorithms were successfully implemented in NLME models using MATLAB with run time differences between the ODE and SDE methods comparable to the differences found by Kakhi for their stochastic deconvolution.

  16. Recent trends in post-wildfire seeding in western US forests: costs and seed mixes

    Science.gov (United States)

    Donna L. Peppin; Peter Z. Fule; Carolyn Hull Sieg; Jan L. Beyers; Molly E. Hunter; Pete Robichaud

    2011-01-01

    Broadcast seeding is one of the most commonly used post-fire rehabilitation treatments to establish ground cover for erosion control and mitigation of non-native plant species invasions. Little quantitative information is available on overall trends of post-fire seeding expenditures and seed mixes used over time in forested ecosystems in the western USA. We reviewed...

  17. A rare case report of 46XY mixed gonadal dysgenesis

    Directory of Open Access Journals (Sweden)

    Rakesh Arora

    2013-01-01

    Full Text Available A 16-year-old person, reared as female presented with complaints of genital ambiguity and primary amenorrhoea along with lack of secondary sexual characters, but without short stature and Turner′s stigmata. She was taking steroids after being misdiagnosed as congenital adrenal hyperplasia (CAH. Karyotype analysis revealed 46XY karyotype. There was no evidence of hypocortisolemia (cortisol 9.08 μg/dl, adrenocorticotropic hormone [ACTH] 82.5 pg/ml or elevated level of 17-OH-progesterone (0.16 ng/ml. Pooled luteinizing hormone (LH was 11.79 mIU/ml and follicle-stimulating hormone (FSH was 66.37 mIU/ml. Serum estradiol level was 25 pg/ml (21-251. Basal and 72 h post beta-human chorionic gonadotropin (hCG levels of androstenedione and testosterone levels were done (basal testosterone of 652 ng/dl and basal androstenedione of 1.17 ng/ml; 72 h post hCG testosterone of 896 ng/dl and androstenedione of 1.34 ng/ml. Magnetic resonance imaging (MRI pelvis (with ultrasonogrphy [USG] correlation revealed uterus didelphys with obstructed right moiety and bilateral ovarian-like structures. Right sided gonads and adjacent tubal structures were visualized laparoscopically and removed. Left sided gonads were not visualized and Mullerian remnants were adhered to sigmoid colon. Histopathological examination revealed presence of testicular tissue showing atrophic seminiferous tubules with hyperplasia of Leydig cells. No ovarian tissue was seen. Based on these results a diagnosis of 46XY mixed gonadal dysgenesis (MGD was made, which is rare and is difficult to distinguish from 46XY ovotesticular disorder of sexual differentiation (OT-DSD. The patient was managed with a multidisciplinary approach and fertility issues discussed with the patient′s caregivers.

  18. The Environmental Impact and Cost Analysis of Concrete Mixing Blast Furnace Slag Containing Titanium Gypsum and Sludge in South Korea

    Directory of Open Access Journals (Sweden)

    Tae Hyoung Kim

    2016-05-01

    Full Text Available This study assessed the environmental effects and cost of the Industrial Waste addictive Blast Furnace Slag (W-BFS using Life Cycle Assessment (LCA and compared it to general BFS. The environmental impacts of W-BFS were as follows: 1.12 × 10−1 kg-CO2 eq/kg, 3.18 × 10−5 kg-Ethylene eq/kg, 4.79 × 10−4 kg-SO2 eq/kg, 7.15 × 10−4 kg-PO43− eq/kg, 7.15 × 10−4 kg-CFC11 eq/kg and 3.94 × 10−3 kg-Antimony eq/kg. Among the environmental impact category, GWP and AP were 9.28 × 10−2 kg-CO2 eq/kg and 3.33 × 10−4 kg-SO2 eq/kg at a raw material stage, accounting for 80% and 70% of total environmental impact respectively. In EP, POCP and ADP, in addition, raw material stage accounted for a great portion in total environmental impact because of “W” among input materials. In ODP, however, compared to the environmental impact of raw materials, oil, which was used in transporting BFS to the W-BFS manufacturing factory, was more influential. In terms of GWP, POCP and ODP, W-BFS was higher than general BFS. In terms of AP, EP and ADP, in contrast, the former was lower than the latter. In terms of cost, W-BFS (41.7 US$/ton was lower than general BFS by about 17% because of the use of waste additives comprised of industrial wastes instead of natural gypsum ,which has been commonly used in general BFS. In terms of GWP and POCP, the W-BFS mixed (30% concrete was lower than plain concrete by 25%. In terms of AP and EP, the former was lower than the latter by 30%. In terms of ADP, furthermore, W-BFS mixed (30% concrete was lower than plain concrete by 11%. In aggregate-related ODP, however, almost no change was found. In terms of cost, when W-BFS was added by 10% and 30%, it was able to reduce cost by 3% and 7% respectively, compared to plain concrete. Compared to BFS-mixed concrete as well, cost could be saved by 1% additionally because W-BFS (US$41.7/ton is lower than common cement (US$100.3/ton by about 60% in terms of production costs.

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

    Science.gov (United States)

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

    2011-01-01

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

  20. MARKETING MIX POLICIES IN FMCG CASE-STUDY: THE ADVERTISING STRATEGY

    OpenAIRE

    ANA MARIA BOBEICA

    2011-01-01

    This paper explores the relationships between selected marketing mix elements in the area of FMCG. It discusses the nature and sometimes negative consequences of the dominating marketing paradigm of today, marketing mix management, and furthermore discusses how modern research into, for example in the case of FMCG Companies, the marketing policies as well as customer relationship tactics shows that another approach to marketing is required. It proposes a conceptual framework in which marketin...

  1. Mixed capillary-cavernous extramedullary intradural hemangioma of the spinal cord mimicking meningioma: Case report.

    Science.gov (United States)

    Alobaid, Abdullah; Bennardo, Michael Ross; Cenic, Aleksa; Lach, Boleslaw

    2015-06-01

    Hemangiomas are customarily described as low-grade vascular tumors most often located in the head and neck, but on rare occasions occurring in the intradural space of the spine. The different subtypes of hemangiomas can be distinguished histologically as capillary, cavernous, or mixed types. We describe a rare case of a mixed capillary-cavernous extramedullary intradural hemangioma of the thoracic spinal cord, mimicking meningioma radiologically.

  2. Technology commercialization cost model and component case study

    Science.gov (United States)

    1991-12-01

    Fuel cells seem poised to emerge as a clean, efficient, and cost competitive source of fossil fuel based electric power and thermal energy. Sponsors of fuel cell technology development need to determine the validity and the attractiveness of a technology to the market in terms of meeting requirements and providing value which exceeds the total cost of ownership. Sponsors of fuel cell development have addressed this issue by requiring the developers to prepare projections of the future production cost of their fuel cells in commercial quantities. These projected costs, together with performance and life projections, provide a preliminary measure of the total value and cost of the product to the customer. Booz-Allen & Hamilton Inc. and Michael A. Cobb & Company have been retained in several assignments over the years to audit these cost projections. The audits have gone well beyond a simple review of the numbers. They have probed the underlying technical and financial assumptions, the sources of data on material and equipment costs, and explored issues such as the realistic manufacturing yields which can be expected in various processes. Based on the experience gained from these audits, DOE gave Booz-Allen and Michael A. Cobb & company the task to develop a criteria to be used in the execution of future fuel cell manufacturing cost studies. It was thought that such a criteria would make it easier to execute such studies in the future as well as to cause such studies to be more understandable and comparable.

  3. Minimum-cost dynamic flows: The series-parallel case

    NARCIS (Netherlands)

    Klinz, Bettina; Woeginger, Gerhard J.

    2004-01-01

    A dynamic network consists of a directed graph with capacities, costs, and integral transit times on the arcs. In the minimum-cost dynamic flow problem (MCDFP), the goal is to compute, for a given dynamic network with source s, sink t, and two integers v and T, a feasible dynamic flow from s to t of

  4. Mixed Hyperlipidemia Associated with Triple X Syndrome (A Case Report

    Directory of Open Access Journals (Sweden)

    Anton-Pǎduraru Dana-Teodora

    2014-06-01

    Full Text Available Lipid metabolism abnormalities in children may be hereditary or secondary to certain diseases (obesity, type 2 diabetes mellitus. Often elevated triglycerides values are associated with high cholesterol values, playing a major role on atherosclerosis. The triple X syndrome also called “the superfemale syndrome” is not a rare condition, but it is usually undiagnosed or occasionally diagnosed when other investigations are done. The authors present the case of a child admitted in the 3rd Clinic of Pediatrics -“Sf. Maria” Children’s Emergency Hospital, Iaşi -Romania for the continuation of her lipid metabolism investigations, being diagnosed on this occasion with the triple X syndrome. We conclude that the investigation of lipid metabolism, early identification of lipid abnormalities and proper treatment significantly reduce the prevalence of cardiovascular disease in adults. We cannot specify the impact of the presence of the chromosomal anomaly, as it is an accidental association

  5. Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.

    Science.gov (United States)

    Hoang, Van Minh; Tran, Tuan Anh; Ha, Anh Duc; Nguyen, Viet Hung

    2015-11-01

    Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption.

  6. Direct and Collateral Effects of Positive Reinforcement, Response Cost, and Mixed Contingencies for Academic Performance

    Science.gov (United States)

    Broughton, Sam F.; Lahey, Benjamin B.

    1978-01-01

    The relative effects of positive reinforcement, response cost, and the two contingencies combined when used as contingencies for correct academic responses were compared on the dependent measures of accuracy of academic performance and level of on-task behavior. All three contingency systems increased academic performance and on-task behavior.…

  7. The operating room case-mix problem under uncertainty and nurses capacity constraints.

    Science.gov (United States)

    Yahia, Zakaria; Eltawil, Amr B; Harraz, Nermine A

    2016-12-01

    Surgery is one of the key functions in hospitals; it generates significant revenue and admissions to hospitals. In this paper we address the decision of choosing a case-mix for a surgery department. The objective of this study is to generate an optimal case-mix plan of surgery patients with uncertain surgery operations, which includes uncertainty in surgery durations, length of stay, surgery demand and the availability of nurses. In order to obtain an optimal case-mix plan, a stochastic optimization model is proposed and the sample average approximation method is applied. The proposed model is used to determine the number of surgery cases to be weekly served, the amount of operating rooms' time dedicated to each specialty and the number of ward beds dedicated to each specialty. The optimal case-mix selection criterion is based upon a weighted score taking into account both the waiting list and the historical demand of each patient category. The score aims to maximizing the service level of the operating rooms by increasing the total number of surgery cases that could be served. A computational experiment is presented to demonstrate the performance of the proposed method. The results show that the stochastic model solution outperforms the expected value problem solution. Additional analysis is conducted to study the effect of varying the number of ORs and nurses capacity on the overall ORs' performance.

  8. Justifying Environmental Cost Allocation in a Multiple Product Firm: A Case Study

    Directory of Open Access Journals (Sweden)

    Collins C. Ngwakwe

    2009-12-01

    Full Text Available This case study examines the effect of environmental cost allocation on production cost and the outcome for environmental management decisions. Using a revised cost allocation – referred to in this paper as environmental cost allocation – the paper contrasts overhead allocation between traditional cost allocation and environmental cost allocation. In addition, production cost derived from the traditional allocation of waste cost is compared with the revised environmental cost allocation. Findings indicate that a revised environmental cost allocation discloses more accurate overhead cost and hence production cost; and that management is motivated to make informed environmental management decisions if a product related environmental cost is made to reflect in the production cost of the polluting product. The paper highlights the practical significance of objective environmental cost allocation on corporate waste management, which thus creates a valuable awareness on the part of the management and accountants of firms in developing countries for the need to fine-tune the dominant traditional costing system. It also suggests avenues for further research to examine the impact of costing systems on environmental investments.

  9. Mixed Model Association with Family-Biased Case-Control Ascertainment.

    Science.gov (United States)

    Hayeck, Tristan J; Loh, Po-Ru; Pollack, Samuela; Gusev, Alexander; Patterson, Nick; Zaitlen, Noah A; Price, Alkes L

    2017-01-05

    Mixed models have become the tool of choice for genetic association studies; however, standard mixed model methods may be poorly calibrated or underpowered under family sampling bias and/or case-control ascertainment. Previously, we introduced a liability threshold-based mixed model association statistic (LTMLM) to address case-control ascertainment in unrelated samples. Here, we consider family-biased case-control ascertainment, where case and control subjects are ascertained non-randomly with respect to family relatedness. Previous work has shown that this type of ascertainment can severely bias heritability estimates; we show here that it also impacts mixed model association statistics. We introduce a family-based association statistic (LT-Fam) that is robust to this problem. Similar to LTMLM, LT-Fam is computed from posterior mean liabilities (PML) under a liability threshold model; however, LT-Fam uses published narrow-sense heritability estimates to avoid the problem of biased heritability estimation, enabling correct calibration. In simulations with family-biased case-control ascertainment, LT-Fam was correctly calibrated (average χ(2) = 1.00-1.02 for null SNPs), whereas the Armitage trend test (ATT), standard mixed model association (MLM), and case-control retrospective association test (CARAT) were mis-calibrated (e.g., average χ(2) = 0.50-1.22 for MLM, 0.89-2.65 for CARAT). LT-Fam also attained higher power than other methods in some settings. In 1,259 type 2 diabetes-affected case subjects and 5,765 control subjects from the CARe cohort, downsampled to induce family-biased ascertainment, LT-Fam was correctly calibrated whereas ATT, MLM, and CARAT were again mis-calibrated. Our results highlight the importance of modeling family sampling bias in case-control datasets with related samples. Copyright © 2017 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

  10. Low-cost domestic water filter: The case for a process-based ...

    African Journals Online (AJOL)

    Low-cost domestic water filter: The case for a process-based approach for the development of a rural technology product. ... The product is a low- cost water filter for which there is a definite need in rural India. The case brings ... Article Metrics.

  11. Hyperketonemia in early lactation dairy cattle: a deterministic estimate of component and total cost per case.

    Science.gov (United States)

    McArt, J A A; Nydam, D V; Overton, M W

    2015-03-01

    The purpose of this study was to develop a deterministic economic model to estimate the costs associated with (1) the component cost per case of hyperketonemia (HYK) and (2) the total cost per case of HYK when accounting for costs related to HYK-attributed diseases. Data from current literature was used to model the incidence and risks of HYK (defined as a blood β-hydroxybutyrate concentration≥1.2 mmol/L), displaced abomasa (DA), metritis, disease associations, milk production, culling, and reproductive outcomes. The component cost of HYK was estimated based on 1,000 calvings per year; the incidence of HYK in primiparous and multiparous animals; the percent of animals receiving clinical treatment; the direct costs of diagnostics, therapeutics, labor, and death loss; and the indirect costs of future milk production losses, future culling losses, and reproduction losses. Costs attributable to DA and metritis were estimated based on the incidence of each disease in the first 30 DIM; the number of cases of each disease attributable to HYK; the direct costs of diagnostics, therapeutics, discarded milk during treatment and the withdrawal period, veterinary service (DA only), and death loss; and the indirect costs of future milk production losses, future culling losses, and reproduction losses. The component cost per case of HYK was estimated at $134 and $111 for primiparous and multiparous animals, respectively; the average component cost per case of HYK was estimated to be $117. Thirty-four percent of the component cost of HYK was due to future reproductive losses, 26% to death loss, 26% to future milk production losses, 8% to future culling losses, 3% to therapeutics, 2% to labor, and 1% to diagnostics. The total cost per case of HYK was estimated at $375 and $256 for primiparous and multiparous animals, respectively; the average total cost per case of HYK was $289. Forty-one percent of the total cost of HYK was due to the component cost of HYK, 33% to costs

  12. Mixed corticomedullary adrenal carcinoma – case report: Comparison in features, treatment and prognosis with the other two reported cases

    Directory of Open Access Journals (Sweden)

    Mhd Belal Alsabek

    2017-01-01

    Conclusion: It could be noted that this is the first comparison of presentation, diagnosis, treatments and follow-up of the three cases of Mixed corticomedullary carcinoma. This could contribute to understanding the behavior and management of this rare malignancy and make it more familiar in clinical practice.

  13. Transaction costs and technological development: The case of the Danish fruit and vegetable industry

    DEFF Research Database (Denmark)

    Foss, Kirsten

    1996-01-01

    It is argued that technological change can be understood in terms of attempts to reduce transaction costs as well as production costs. Two types of paths of technological development are identified: a production cost minimizing path, and a transac cost minimizing path. The creation of new technol...... in addition to the conventional production perspective. The theoretical points are continiuously illustrated by the case of technological development in the Danish fruit and vegetable industry....

  14. Variability in prescription drug expenditures explained by adjusted clinical groups (ACG case-mix: A cross-sectional study of patient electronic records in primary care

    Directory of Open Access Journals (Sweden)

    Serrat Josep

    2008-03-01

    Full Text Available Abstract Background In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. Methods We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. Results No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%. For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%. Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41 and -0.52 in pediatricians (p = 0.08, N = 12. Conclusion In our setting, ACG is the variable studied that explains more variability in

  15. Variability in prescription drug expenditures explained by adjusted clinical groups (ACG) case-mix: a cross-sectional study of patient electronic records in primary care.

    Science.gov (United States)

    Aguado, Alba; Guinó, Elisabet; Mukherjee, Bhramar; Sicras, Antoni; Serrat, Josep; Acedo, Mateo; Ferro, Juan Jose; Moreno, Victor

    2008-03-04

    In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%). For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%). Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41) and -0.52 in pediatricians (p = 0.08, N = 12). In our setting, ACG is the variable studied that explains more variability in pharmacy cost in adults compared to physician and center. In

  16. Reduction of costs of iron production by changing parameters of the mixed blast-furnace wind

    Directory of Open Access Journals (Sweden)

    J. Terpák

    2010-04-01

    Full Text Available The blast-furnace wind from hot-blast stoves is a significant factor of the blast furnace functioning. The technology was analyzed in which the hot wind from hot-blast stoves is not mixed with the cool wind to a constant wind temperature, but is blown directly into the blast furnace. However, it is necessary to compensate for the changes of the theoretical temperature of burning in blast furnace as a consequence of non-stabilized wind temperature, by changing composition of the wind. This can be done by adding different media into the wind with different results from the operational and economical viewpoints. Essentially, the following types of media are used in blast furnaces: steam, oxygen, substitution fuels, nitrogen, and waste gas.

  17. Cost per case or total cost? The potential of prevention of hand injuries in young children – Retrospective and prospective studies

    Directory of Open Access Journals (Sweden)

    Carlsson Katarina

    2008-07-01

    Full Text Available Abstract Background Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996–2003. Methods Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategies were constructed. Results Over time, diminishing number of ward days reduced the health-care cost per case. Among children, the cost of lost productivity due to parental leave was 14 percent of total cost. Fingertip injuries had low median costs but high total costs due to their frequency. Complex injuries by machine or rifle had high costs per case, and despite a low number of cases, total cost was high. Type of injury, surgery and physiotherapy sessions were associated with variations in health-care cost. Low age and ethnic background had a significant effect on number of ward days. Conclusion The costs per hand injury for children were lower compared to adults due to both lower health-care costs and to the fact that parents had comparatively short periods of absence from work. Frequent simple fingertip injuries and rare complex injuries induce high costs for society. Such costs should be related to costs for prevention of these injuries.

  18. Using case-mix information in strategic hospital marketing. Deriving market research from patient data.

    Science.gov (United States)

    Little, A

    1992-01-01

    Hospital survival requires adaptation, adaptation requires understanding, and understanding requires information. These are the basic equations behind hospital strategic marketing, and one of the answers may lie in hospitals' own patient-data systems. Marketers' and administrators' enlightened application of case-mix information could become one more hospital survival tool.

  19. Words Speak Louder than Action?: A Mixed-Methods Case Study

    Science.gov (United States)

    Vincent, Stacy K.; Kirby, Andrea T.

    2015-01-01

    The purpose of this mixed-methods case study was to examine the dynamic of Culturally Responsive Pedagogy (Gay, 2010) among nine secondary agriculture teachers in ethnically diverse schools. By reviewing the diversity of student enrollment in the agriculture programs, the participants were separated by two groups: diverse and non-diverse. A hybrid…

  20. Mixed Methods Case Study of Generational Patterns in Responses to Shame and Guilt

    Science.gov (United States)

    Ng, Tony

    2013-01-01

    Moral socialization and moral learning are antecedents of moral motivation. As many as 4 generations interact in workplace and education settings; hence, a deeper understanding of the moral motivation of members of those generations is needed. The purpose of this convergent mixed methods case study was to understand the moral motivation of 5…

  1. A methodology to compare specialized and mixed farming systems : case studies, in the Netherlands and France

    NARCIS (Netherlands)

    Guillaume, D.; PRI,

    2012-01-01

    In this thesis, the aim was to create a methodology, composed of a set of economic, social and environmental indicators, in order to compare mixed and specialized farming system and to test the methodology in two case studies in the Netherlands and in France. The analysis relies on two farm typologi

  2. Mixed transcortical aphasia. On relative sparing of phonological short-term store in a case.

    Science.gov (United States)

    Trojano, L; Fragassi, N A; Postiglione, A; Grossi, D

    1988-01-01

    A case of Mixed Transcortical Aphasia is reported. The patient showed completely impaired verbal comprehension and speech production, with preservation of automatic speaking and singing; repetition was relatively spared. A detailed study of word and nonword repetition is reported, in order to demonstrate that the patient's residual repetition ability is based on relative sparing of short-term phonological store.

  3. Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands

    NARCIS (Netherlands)

    Kolfschoten, N.E.; Marang van de Mheen, P.J.; Gooiker, G.A.; Eddes, E.H.; Kievit, J.; Tollenaar, R.A.E.M.; Wouters, M.W.; Bemelman, W.A.; Busch, O.R.; Dam, R.M. van; Harst, E. van der; Jansen-Landheer, M.L.E.A; Karsten, T.M.; Krieken, J.H.J.M. van; Kuijpers, W.G.T.; Lemmens, V.E.; Manusama, E.R.; Meijerink, W.J.H.J.; Rutten, H.J.; Wiggers, T.; Velde, C.J. van de

    2011-01-01

    AIMS: The purpose of this study was to determine how expected mortality based on case-mix varies between colorectal cancer patients treated in non-teaching, teaching and university hospitals, or high, intermediate and low-volume hospitals in the Netherlands. MATERIAL AND METHODS: We used the databas

  4. Imaging Findings in a Case of Mixed Acinar-Endocrine Carcinoma of the Pancreas

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Won Jung; Byun, Jae Ho; Lee, Seung Soo; Lee, Moon Gyu [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2010-06-15

    Mixed acinar-endocrine carcinoma (MAEC) of the pancreas is extremely uncommon. We report here a rare case of MAEC of the pancreas presenting as watery diarrhea. This is the first report in the English-language literature that describes the imaging findings of MAEC of the pancreas, including computed tomography (CT), magnetic resonance (MR) imaging, and MR cholangiopancreatography features

  5. Mixed Methods Case Study of Generational Patterns in Responses to Shame and Guilt

    Science.gov (United States)

    Ng, Tony

    2013-01-01

    Moral socialization and moral learning are antecedents of moral motivation. As many as 4 generations interact in workplace and education settings; hence, a deeper understanding of the moral motivation of members of those generations is needed. The purpose of this convergent mixed methods case study was to understand the moral motivation of 5…

  6. A methodology to compare specialized and mixed farming systems : case studies, in the Netherlands and France

    NARCIS (Netherlands)

    Guillaume, D.; PRI,

    2012-01-01

    In this thesis, the aim was to create a methodology, composed of a set of economic, social and environmental indicators, in order to compare mixed and specialized farming system and to test the methodology in two case studies in the Netherlands and in France. The analysis relies on two farm typologi

  7. The Effect of English Language Learning on Creative Thinking Skills: A Mixed Methods Case Study

    Science.gov (United States)

    Sehic, Sandro

    2017-01-01

    The purpose of this sequential explanatory mixed-methods case study was to investigate the effects of English language learning on creative thinking skills in the domains of fluency, flexibility, originality, and elaboration as measured with the Alternate Uses Test. Unlike the previous research studies that investigated the links between English…

  8. Energy Cost Optimization in a Water Supply System Case Study

    Directory of Open Access Journals (Sweden)

    Daniel F. Moreira

    2013-01-01

    Full Text Available The majority of the life cycle costs (LCC of a pump are related to the energy spent in pumping, with the rest being related to the purchase and maintenance of the equipment. Any optimizations in the energy efficiency of the pumps result in a considerable reduction of the total operational cost. The Fátima water supply system in Portugal was analyzed in order to minimize its operational energy costs. Different pump characteristic curves were analyzed and modeled in order to achieve the most efficient operation point. To determine the best daily pumping operational scheduling pattern, genetic algorithm (GA optimization embedded in the modeling software was considered in contrast with a manual override (MO approach. The main goal was to determine which pumps and what daily scheduling allowed the best economical solution. At the end of the analysis it was possible to reduce the original daily energy costs by 43.7%. This was achieved by introducing more appropriate pumps and by intelligent programming of their operation. Given the heuristic nature of GAs, different approaches were employed and the most common errors were pinpointed, whereby this investigation can be used as a reference for similar future developments.

  9. Sarbanes Oxley section 404 costs of compliance : A case study

    NARCIS (Netherlands)

    Sneller, A.C.W.(L.); Langendijk, H.P.A.J.

    2007-01-01

    In 2002 US Congress approved the Sarbanes Oxley Act (SOX). Section 404 requires companies to assess their internal controls and acquire an attestation of this assessment from their external auditor. In this paper, we investigate the costs of compliance of this assessment and attestation. The Europea

  10. Sarbanes Oxely Section 404 costs of compliance: a case study

    NARCIS (Netherlands)

    Sneller, L.; Langendijk, H.

    2007-01-01

    In 2002 US Congress approved the Sarbanes Oxley Act (SOX). Section 404 requires companies to assess their internal controls and acquire an attestation of this assessment from their external auditor. In this paper, we investigate the costs of compliance of this assessment and attestation. The Europea

  11. Sarbanes Oxely Section 404 costs of compliance: a case study

    NARCIS (Netherlands)

    Sneller, L.; Langendijk, H.

    2007-01-01

    In 2002 US Congress approved the Sarbanes Oxley Act (SOX). Section 404 requires companies to assess their internal controls and acquire an attestation of this assessment from their external auditor. In this paper, we investigate the costs of compliance of this assessment and attestation. The Europea

  12. Sarbanes Oxley section 404 costs of compliance : A case study

    NARCIS (Netherlands)

    Sneller, A.C.W.(L.); Langendijk, H.P.A.J.

    2007-01-01

    In 2002 US Congress approved the Sarbanes Oxley Act (SOX). Section 404 requires companies to assess their internal controls and acquire an attestation of this assessment from their external auditor. In this paper, we investigate the costs of compliance of this assessment and attestation. The Europea

  13. Interaction between Total Cost and Fill Rate: A Case Study

    Directory of Open Access Journals (Sweden)

    Liljana Ferbar Tratar

    2016-09-01

    Full Text Available Forecasting plays a central role in the efficient operation of a supply chain – i.e., the total costs and fill rate. As forecasts of demand are required on a regular basis for a very large number of products, the methods developed should be fast, flexible, user-friendly, and able to produce results that are reliable and easy to interpret by a manager. In this paper we show that the supply chain costs cannot be optimal if the forecasting method is treated separately from the inventory model. We analyse the performance of the joint optimization of the modified Holt-Winters forecasting method and a stock control policy and investigate the effect of different penalties for unsatisfied demand on the total cost and fill rate of the supply chain. From the results obtained with 1,428 real time series from M3-Competition we show that an essential reduction of supply chain costs and an increase of fill rate can be achieved if we use the joint model with the modified Holt-Winters method.

  14. Cost-Effectiveness Analysis of Three Leprosy Case Detection Methods in Northern Nigeria

    Science.gov (United States)

    Ezenduka, Charles; Post, Erik; John, Steven; Suraj, Abdulkarim; Namadi, Abdulahi; Onwujekwe, Obinna

    2012-01-01

    Background Despite several leprosy control measures in Nigeria, child proportion and disability grade 2 cases remain high while new cases have not significantly reduced, suggesting continuous spread of the disease. Hence, there is the need to review detection methods to enhance identification of early cases for effective control and prevention of permanent disability. This study evaluated the cost-effectiveness of three leprosy case detection methods in Northern Nigeria to identify the most cost-effective approach for detection of leprosy. Methods A cross-sectional study was carried out to evaluate the additional benefits of using several case detection methods in addition to routine practice in two north-eastern states of Nigeria. Primary and secondary data were collected from routine practice records and the Nigerian Tuberculosis and Leprosy Control Programme of 2009. The methods evaluated were Rapid Village Survey (RVS), Household Contact Examination (HCE) and Traditional Healers incentive method (TH). Effectiveness was measured as number of new leprosy cases detected and cost-effectiveness was expressed as cost per case detected. Costs were measured from both providers' and patients' perspectives. Additional costs and effects of each method were estimated by comparing each method against routine practise and expressed as incremental cost-effectiveness ratio (ICER). All costs were converted to the U.S. dollar at the 2010 exchange rate. Univariate sensitivity analysis was used to evaluate uncertainties around the ICER. Results The ICER for HCE was $142 per additional case detected at all contact levels and it was the most cost-effective method. At ICER of $194 per additional case detected, THs method detected more cases at a lower cost than the RVS, which was not cost-effective at $313 per additional case detected. Sensitivity analysis showed that varying the proportion of shared costs and subsistent wage for valuing unpaid time did not significantly change the

  15. Case-mix adjustment for evaluation of mortality in cystic fibrosis.

    Science.gov (United States)

    O'Connor, Gerald T; Quinton, Hebe B; Kahn, Richard; Robichaud, Priscilla; Maddock, Joanne; Lever, Thomas; Detzer, Mark; Brooks, John G

    2002-02-01

    Comparison of patient mortality rates in cystic fibrosis (CF) obtained from different institutions requires the use of case-mix adjustment methods to account for baseline differences in patient and disease characteristics. There is no current professional consensus on the use of case-mix adjustment methods for use in comparing mortality rates in CF. Characteristics used for this case-mix adjustment should include those that are different across institutions and are associated with patient survival. They should not include characteristics of disease severity that may be a consequence of effectiveness of treatment. The goal of these analyses was to identify a set of these characteristics of patients or disease that would be useful for case-mix adjustment of CF mortality rates. Data from the Cystic Fibrosis Foundation Patient Registry and from the United States Census of the Population (1990) were used in these analyses. Kaplan-Meier techniques, the log-rank test, and Cox proportional hazards regression were used to estimate survivorship, calculate hazard ratios (HR), 95% confidence intervals (CI(95%)), and to conduct tests of statistical significance. The data set included all 30,469 CF patients seen at CF Care Centers from 1982-1998. There were 5,906 deaths during 508,721 person-years of follow-up. In multivariate analyses, female gender (HR 1.30, CI(95%) (1.16, 1,47), P $50,000/year (corrected for the 1999 consumer price index) were compared with those living in areas with a median household income uses patient and disease characteristics available at the time of diagnosis of CF, and is not believed to be influenced by subsequent treatment to predict the risk of death. If these case-mix adjustment methods are adopted broadly, they will make it possible to study treatment effects and differences in mortality outcomes, while adjusting for baseline differences in patient and disease characteristics.

  16. Economic consequences of legal and illegal drugs: The case of social costs in Belgium.

    Science.gov (United States)

    Lievens, Delfine; Vander Laenen, Freya; Verhaeghe, Nick; Putman, Koen; Pauwels, Lieven; Hardyns, Wim; Annemans, Lieven

    2017-06-01

    Legal and illegal drugs impose a considerable burden to the individual and to society. The misuse of addictive substances results in healthcare and law enforcement costs, loss of productivity and reduced quality of life. A social cost study was conducted to estimate the substance-attributable costs of alcohol, tobacco, illegal drugs and psychoactive medication to Belgian society in 2012. The cost-of-illness framework with prevalence-based and human capital approach was applied. Three cost components were considered: direct, indirect and intangible costs related to substance misuse. The direct and indirect cost of addictive substances was estimated at 4.6 billion euros in Belgium (419 euros per capita or 1.19% of the GDP) and more than 515,000 healthy years are lost due to substance misuse. The Belgian social cost study reaffirms that alcohol and tobacco impose the highest cost to society compared to illegal drugs. Health problems are the main driver of the social cost of legal drugs. Law enforcement expenditure exceed the healthcare costs but only in the case of illegal drugs. Estimating social costs of addictive substances is complex because it is difficult to determine to what extent the societal harm is caused by substances. It can be argued that social cost studies take only a 'snapshot' of the monetary consequences of substance misuse. Nevertheless, the current study offers the most comprehensive analysis thus far of the social costs of substance misuse in Belgium. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Cost-sensitive case-based reasoning using a genetic algorithm: application to medical diagnosis.

    Science.gov (United States)

    Park, Yoon-Joo; Chun, Se-Hak; Kim, Byung-Chun

    2011-02-01

    The paper studies the new learning technique called cost-sensitive case-based reasoning (CSCBR) incorporating unequal misclassification cost into CBR model. Conventional CBR is now considered as a suitable technique for diagnosis, prognosis and prescription in medicine. However it lacks the ability to reflect asymmetric misclassification and often assumes that the cost of a positive diagnosis (an illness) as a negative one (no illness) is the same with that of the opposite situation. Thus, the objective of this research is to overcome the limitation of conventional CBR and encourage applying CBR to many real world medical cases associated with costs of asymmetric misclassification errors. The main idea involves adjusting the optimal cut-off classification point for classifying the absence or presence of diseases and the cut-off distance point for selecting optimal neighbors within search spaces based on similarity distribution. These steps are dynamically adapted to new target cases using a genetic algorithm. We apply this proposed method to five real medical datasets and compare the results with two other cost-sensitive learning methods-C5.0 and CART. Our finding shows that the total misclassification cost of CSCBR is lower than other cost-sensitive methods in many cases. Even though the genetic algorithm has limitations in terms of unstable results and over-fitting training data, CSCBR results with GA are better overall than those of other methods. Also the paired t-test results indicate that the total misclassification cost of CSCBR is significantly less than C5.0 and CART for several datasets. We have proposed a new CBR method called cost-sensitive case-based reasoning (CSCBR) that can incorporate unequal misclassification costs into CBR and optimize the number of neighbors dynamically using a genetic algorithm. It is meaningful not only for introducing the concept of cost-sensitive learning to CBR, but also for encouraging the use of CBR in the medical area

  18. The cost of segregating GM canola: A case study

    OpenAIRE

    Hatwell, Bronwyn; Pluske, Johanna M.

    2004-01-01

    The Gene Technology Regulator's approval of Bayer CropScience's genetically modified (GM) canola variety, InVigor, and Monsanto's Roundup Ready, means that the commercial planting of Australia's first GM food crop is imminent. Under such circumstances, for Australia to continue marketing non-GM canola and comply with worldwide labelling requirements segregation must be implemented. This study investigates the cost effectiveness of three possible segregation methods. In considering each of the...

  19. Mixed reality ultrasound guidance system: a case study in system development and a cautionary tale.

    Science.gov (United States)

    Ameri, Golafsoun; Baxter, John S H; Bainbridge, Daniel; Peters, Terry M; Chen, Elvis C S

    2017-08-31

    Real-time ultrasound has become a crucial aspect of several image-guided interventions. One of the main constraints of such an approach is the difficulty in interpretability of the limited field of view of the image, a problem that has recently been addressed using mixed reality, such as augmented reality and augmented virtuality. The growing popularity and maturity of mixed reality has led to a series of informal guidelines to direct development of new systems and to facilitate regulatory approval. However, the goals of mixed reality image guidance systems and the guidelines for their development have not been thoroughly discussed. The purpose of this paper is to identify and critically examine development guidelines in the context of a mixed reality ultrasound guidance system through a case study. A mixed reality ultrasound guidance system tailored to central line insertions was developed in close collaboration with an expert user. This system outperformed ultrasound-only guidance in a novice user study and has obtained clearance for clinical use in humans. A phantom study with 25 experienced physicians was carried out to compare the performance of the mixed reality ultrasound system against conventional ultrasound-only guidance. Despite the previous promising results, there was no statistically significant difference between the two systems. Guidelines for developing mixed reality image guidance systems cannot be applied indiscriminately. Each design decision, no matter how well justified, should be the subject of scientific and technical investigation. Iterative and small-scale evaluation can readily unearth issues and previously unknown or implicit system requirements. We recommend a wary eye in development of mixed reality ultrasound image guidance systems emphasizing small-scale iterative evaluation alongside system development. Ultimately, we recommend that the image-guided intervention community furthers and deepens this discussion into best practices in

  20. Mixed thermal convection: fundamental issues and analysis of the planar case

    Directory of Open Access Journals (Sweden)

    JACQUES PADET

    2015-09-01

    Full Text Available This paper aims to renew interest on mixed thermal convection research and to emphasize three issues that arise from the present analysis: (i a clear definition of the reference temperature in the Boussinesq approximation; (ii a practical delimitation of the three convective modes, which are the forced convection (FC, mixed convection (MC and natural (or free convection (NC; (iii and, finally, a uniform description of the set FC/MC/NC in the similarity framework. The planar case, for which analytical solutions are available, allows a detailed illustration of the answers here advanced to the above issues.

  1. Life cycle costing of waste management systems: Overview, calculation principles and case studies

    Energy Technology Data Exchange (ETDEWEB)

    Martinez-Sanchez, Veronica, E-mail: vems@env.dtu.dk [Technical University of Denmark, Department of Environmental Engineering, Miljoevej, Building 113, 2800 Kgs. Lyngby (Denmark); Kromann, Mikkel A. [COWI A/S, Parallelvej 2, 2800 Kgs. Lyngby (Denmark); Astrup, Thomas Fruergaard [Technical University of Denmark, Department of Environmental Engineering, Miljoevej, Building 113, 2800 Kgs. Lyngby (Denmark)

    2015-02-15

    Highlights: • We propose a comprehensive model for cost assessment of waste management systems. • The model includes three types of LCC: Conventional, Environmental and Societal LCCs. • The applicability of the proposed model is tested with two case studies. - Abstract: This paper provides a detailed and comprehensive cost model for the economic assessment of solid waste management systems. The model was based on the principles of Life Cycle Costing (LCC) and followed a bottom-up calculation approach providing detailed cost items for all key technologies within modern waste systems. All technologies were defined per tonne of waste input, and each cost item within a technology was characterised by both a technical and an economic parameter (for example amount and cost of fuel related to waste collection), to ensure transparency, applicability and reproducibility. Cost items were classified as: (1) budget costs, (2) transfers (for example taxes, subsidies and fees) and (3) externality costs (for example damage or abatement costs related to emissions and disamenities). Technology costs were obtained as the sum of all cost items (of the same type) within a specific technology, while scenario costs were the sum of all technologies involved in a scenario. The cost model allows for the completion of three types of LCC: a Conventional LCC, for the assessment of financial costs, an Environmental LCC, for the assessment of financial costs whose results are complemented by a Life Cycle Assessment (LCA) for the same system, and a Societal LCC, for socio-economic assessments. Conventional and Environmental LCCs includes budget costs and transfers, while Societal LCCs includes budget and externality costs. Critical aspects were found in the existing literature regarding the cost assessment of waste management, namely system boundary equivalency, accounting for temporally distributed emissions and impacts, inclusions of transfers, the internalisation of environmental

  2. Battery energy storage systems life cycle costs case studies

    Energy Technology Data Exchange (ETDEWEB)

    Swaminathan, S.; Miller, N.F.; Sen, R.K. [SENTECH, Inc., Bethesda, MD (United States)

    1998-08-01

    This report presents a comparison of life cycle costs between battery energy storage systems and alternative mature technologies that could serve the same utility-scale applications. Two of the battery energy storage systems presented in this report are located on the supply side, providing spinning reserve and system stability benefits. These systems are compared with the alternative technologies of oil-fired combustion turbines and diesel generators. The other two battery energy storage systems are located on the demand side for use in power quality applications. These are compared with available uninterruptible power supply technologies.

  3. A case of the vibrant soundbridge stapes coupler in patients with mixed hearing loss.

    Science.gov (United States)

    Park, Ah Young; Jeon, Ju Hyun; Moon, In Seok; Choi, Jae Young

    2014-09-01

    The Vibrant Soundbridge (VSB) with stapes clip coupler placement at the stapes head has been used successfully to treat mixed hearing loss. Coupling between the floating mass transducer of the VSB and the stapes head is technically less demanding than incus vibroplasty and is more likely to generate a positive outcome without significantly changing residual hearing or resulting in medical or surgical complications. A 65-year-old man with bilateral mixed hearing loss and chronic otitis media underwent vibroplasty with a stapes clip coupler. Speech discrimination scores in both quiet and noise environments showed better functional gain with the VSB than with the use of a conventional hearing aid. The results of the present case show the feasibility of implanting a VSB with a stapes coupler in patients with mixed hearing loss due to chronic otitis media.

  4. Orthodontic Management of a Severely Rotated Maxillary Central Incisor in the Mixed Dentition: A Case Report

    Directory of Open Access Journals (Sweden)

    Arezoo Jahanbin

    2014-06-01

    Full Text Available The aim of this case report was to introduce an appliance for correcting severe rotation of anterior teeth in the mixed dentition period. A 9-year-old Iranian boy with a mixed dentition Class I malocclusion complained of a severely rotated of upper right central incisor. There was a mesiodens between the central incisors. The supernumerary tooth was first extracted and then a Whip appliance which is composed of a removable plate, a cantilever spring and a central bracket on the rotated tooth was utilized. After 8 months, the upper right central incisor was orthodontically brought into proper alignment. Circumferential supracrestal fibrotomy was performed on the overcorrected tooth. One week after surgery, the device was removed and the retention was started. The whip appliance is a removable appliance that can effectively correct severe rotation of anterior teeth especially during the mixed dentition period.

  5. The energy cost of water independence: the case of Singapore.

    Science.gov (United States)

    Vincent, Lenouvel; Michel, Lafforgue; Catherine, Chevauché; Pauline, Rhétoré

    2014-01-01

    Finding alternative resources to secure or increase water availability is a key issue in most urban areas. This makes the research of alternative and local water resources of increasing importance. In the context of political tension with its main water provider (Malaysia), Singapore has been implementing a comprehensive water policy for some decades, which relies on water demand management and local water resource mobilisation in order to reach water self-sufficiency by 2060. The production of water from alternative resources through seawater desalination or water reclamation implies energy consumptive technologies such as reverse osmosis. In the context of increasing energy costs and high primary energy dependency, this water self-sufficiency objective is likely to be an important challenge for Singapore. The aim of this paper is to quantify the long-term impact of Singapore's water policy on the national electricity bill and to investigate the impact of Singapore's projects to reduce its water energy footprint. We estimate that 2.0% of the Singaporean electricity demand is already dedicated to water and wastewater treatment processes. If its water-energy footprint dramatically increases in the coming decades, ambitious research projects may buffer the energy cost of water self-sufficiency.

  6. Ameloblastic fibroma: A rare case appearing as a mixed radiographic image.

    Science.gov (United States)

    de Castro, Jurema-Freire-Lisboa; Correia, Andreza-Veruska-Lira; Santos, Lucas-Alexandre-Moraes; Guerra, Luiz-Antônio-Portela; Ramos-Perez, Flávia-Maria-de-Moraes; Perez, Danyel-Elias-da Cruz

    2014-12-01

    Ameloblastic fibroma (AF) is a benign tumor of mixed odontogenic origin, which affects predominantly young individuals. AF appearing as a mixed radiographic image is very rare. This report describes a case of AF in a 12-year-old male identified during a routine radiographic exam for orthodontic treatment planning. The panoramic radiography revealed a well-defined multilocular mixed image located in the mandible between the roots of the left mandibular second premolar and first molar. The lesion was excised under local anesthesia. Histopathological analysis revealed islands of epithelial cells and columnar peripheral cells showing a nucleus in inverted polarization, interspersed with spindle-shaped cells and abundant extracellular matrix deposition. No atypia was observed. The diagnosis of AF was established. No tumor recurred up to 30 months after treatment. Although rare, AF should be also considered in the differential diagnosis of mixed radiographic images of the jaws in young patients. Key words:Ameloblastic fibroma, differential diagnosis, incidental finding, mixed image, radiographic features.

  7. HOW TO CALCULATE THE ENVIRONMENTAL COSTS? CASE COMPANY GRAFICA CIENFUEGOS

    Directory of Open Access Journals (Sweden)

    Keitel, Becerra

    2011-01-01

    Full Text Available The world urgently needs to protect the environment, many companies and organizations devote huge resources to reach that goal and achieve sustainable development as the highest standard of achievement for any country or organization. It then becomes imperative to determine how much the companies spend on the environment, taking into account that the Entities have an implicit contract with society and the environment, the product of the resources used and waste and waste pouring, which is why one needs to calculate and record the environmental costs of products to enhance the environmental management of the entity and thus promote an excellent decision-making. The following research seeks a procedure which allows solving this problem, making its composition with the use of various techniques within which highlights the environmental checklists and product life cycle, which also allows knowing separately as each process and product impacts the environment.

  8. Improved Cost Management at Small and Medium Sized Road Transport Companies: Case Hungary

    Directory of Open Access Journals (Sweden)

    Zoltan Bokor

    2015-10-01

    Full Text Available Small and medium sized road freight transport companies located in Hungary are facing strong competition on the logistics market. An advanced cost management system supporting decisions on capacity allocations or pricing may be a competitive advantage for them and indirectly for the whole economy as well. Still, they generally apply simple, traditional cost calculation regimes, potentially sufficient in case of a homogeneous service portfolio. Nevertheless, road haulage companies with heterogeneous service structures may witness information distortions when using traditional costing methods. So it might be recommended for them to introduce better costing principles. To support an improved transport costing, a multi-level full cost allocation model has been set up and tested in this paper. The research results have pointed out that such a methodological development accompanied by the extension of the data collection mechanism can contribute to making the cost management systems of road freight transport companies more effective.

  9. MARKETING MIX POLICIES IN FMCG CASE-STUDY: THE ADVERTISING STRATEGY

    Directory of Open Access Journals (Sweden)

    ANA MARIA BOBEICA

    2011-04-01

    Full Text Available This paper explores the relationships between selected marketing mix elements in the area of FMCG. It discusses the nature and sometimes negative consequences of the dominating marketing paradigm of today, marketing mix management, and furthermore discusses how modern research into, for example in the case of FMCG Companies, the marketing policies as well as customer relationship tactics shows that another approach to marketing is required. It proposes a conceptual framework in which marketing elements are related to the dimensions of brand equity and brand awareness. It also presents a case study deriving from advertising strategies of FMCG Companies showing that the change in advertising spending is related to changes in market share, changes in product plans and changes in the number of competitors modified by the number of customers, their concentration and the size of the advertising budget.

  10. Mixed Medullary-follicular Thyroid Carcinoma: Report of a Case and Review of the Literature

    Institute of Scientific and Technical Information of China (English)

    Xiangtao Ma; Liwei Yu; Jing Fu; Shan Wang; Ruyu Du; Zhirong Cui

    2005-01-01

    @@ Mixed medullary-follicular carcinomas (MMFCs) are tumors of the thyroid that display morphological and immunohistochemical features of both medullary and follicular neoplasms. These tumors are rare and less than 40 cases have been described in the literature since the early 1980s.[1] The term medullary-follicular thyroid carcinoma denotes a tumor which exhibits the features of a medullary carcinoma and shows positive expression of calcitonin on immunohistochemistry.

  11. Do Social Computing Make You Happy? A Case Study of Nomadic Children in Mixed Environments

    DEFF Research Database (Denmark)

    Christensen, Bent Guldbjerg

    2005-01-01

    In this paper I describe a perspective on ambient, ubiquitous, and pervasive computing called the happiness perspective. By using the happiness perspective, the application domain and how the technology is used and experienced, becomes a central and integral part of perceiving ambient technology....... will use the perspective in a case study on field test experiments with nomadic children in mixed environments using the eBag system....

  12. Special Features In Turbulent Mixing. Comparison between Periodic and Non Periodic Case

    Directory of Open Access Journals (Sweden)

    Mihai Costescu

    2006-12-01

    Full Text Available After hundreds of years of stability study, the problems of flow kinematics are far from complete solving. A modern theory appears in this field: the mixing theory. Its mathematical methods and techniques developed the significant relation between turbulence and chaos. The turbulence is an important feature of dynamic systems with few freedom degrees, the so-called far from equilibrium systems. These are widespread between the models of excitable media.Studying a mixing for a flow implies the analysis of successive stretching and folding phenomena for its particles, the influence of parameters and initial conditions. In the previous works, the study of the 3D non-periodic models exhibited a quite complicated behavior, involving some significant events - the so-called rare events. The variation of parameters had a great influence on the length and surface deformations. The 2D (periodic case is simpler, but significant events can also issue for irrational values of the length and surface versors, as was the situation in 3D case.The comparison between 2D and 3D case revealed interesting properties; therefore a modified 2D (periodic model is tested. The numerical simulations were realized in MapleVI, for searching special mathematical events. Continuing this work both from analytical and numeric standpoint would relieve useful properties for the turbulent mixing. A proximal target is to test some special functions for the periodic model, and to study the behavior of the structures realized by the model.

  13. Life cycle costing of waste management systems: overview, calculation principles and case studies.

    Science.gov (United States)

    Martinez-Sanchez, Veronica; Kromann, Mikkel A; Astrup, Thomas Fruergaard

    2015-02-01

    This paper provides a detailed and comprehensive cost model for the economic assessment of solid waste management systems. The model was based on the principles of Life Cycle Costing (LCC) and followed a bottom-up calculation approach providing detailed cost items for all key technologies within modern waste systems. All technologies were defined per tonne of waste input, and each cost item within a technology was characterised by both a technical and an economic parameter (for example amount and cost of fuel related to waste collection), to ensure transparency, applicability and reproducibility. Cost items were classified as: (1) budget costs, (2) transfers (for example taxes, subsidies and fees) and (3) externality costs (for example damage or abatement costs related to emissions and disamenities). Technology costs were obtained as the sum of all cost items (of the same type) within a specific technology, while scenario costs were the sum of all technologies involved in a scenario. The cost model allows for the completion of three types of LCC: a Conventional LCC, for the assessment of financial costs, an Environmental LCC, for the assessment of financial costs whose results are complemented by a Life Cycle Assessment (LCA) for the same system, and a Societal LCC, for socio-economic assessments. Conventional and Environmental LCCs includes budget costs and transfers, while Societal LCCs includes budget and externality costs. Critical aspects were found in the existing literature regarding the cost assessment of waste management, namely system boundary equivalency, accounting for temporally distributed emissions and impacts, inclusions of transfers, the internalisation of environmental impacts and the coverage of shadow prices, and there was also significant confusion regarding terminology. The presented cost model was implemented in two case study scenarios assessing the costs involved in the source segregation of organic waste from 100,000 Danish households and

  14. Mixed Salmonella infection: a report of two cases from the Aga Khan University Hospital, Karachi.

    Science.gov (United States)

    Sultan, Binish Arif; Fasih, Naima; Qaiser, Saba; Khan, Erum; Zafar, Afia; Irfan, Seema

    2013-04-01

    Enteric fever remains a major health problem in the developing world, including Pakistan. Poor sanitation and hygienic conditions are the major predisposing factors. Salmonella infection with different strains in the same patient has rarely been reported previously. We are reporting two cases of bacteraemia with simultaneous detection of two strains of Salmonella in a single episode of infection. In both the cases, 2 different serotypes of Salmonella were causing bacteraemia leading to fever. In highly endemic area, one must be aware of mixed Salmonella infections as inappropriate diagnosis of such infections may lead to treatment failure.

  15. Software Cost Estimation Model Based on Integration of Multi-agent and Case-Based Reasoning

    Directory of Open Access Journals (Sweden)

    Hasan Al-Sakran

    2006-01-01

    Full Text Available Accurate software cost estimation is a vital task that affects the firm's software investment decisions before committing required resources to that project or bidding for a contract. This study proposes an improved Case-Based Reasoning (CBR approach integrated with multi-agent technology to retrieve similar projects from multi-organizational distributed datasets. The study explores the possibility of building a software cost estimation model by collecting software cost data from distributed predefined project cost databases. The model applying CBR method to find similar projects in historical data derived from measured software projects developed by different organizations.

  16. Gestão de custos florestais: um estudo de caso utilizando o Activity-Based Costing Forest management costs: a case study utilizing Activity-Based Costing

    Directory of Open Access Journals (Sweden)

    Alcir Ribeiro Carneiro de Almeida

    1999-08-01

    Full Text Available No atual cenário de industrialização globalizada, tornou-se fundamental a eficácia no gerenciamento dos custos considerados inevitavelmente necessários. Programas convencionais de redução dos custos não consideram o grau de agregação de valor das atividades de rotina pela distorção dos sistemas contábeis atuais. No presente estudo, apresentam-se os principais motivos da falta de relevância das informações de custo, comenta-se sobre o problema da redução de desperdícios florestais e suas conseqüências. A partir de um estudo de caso em uma empresa do setor florestal, demonstra-se uma simulação do Activity Based Costing (ABC em uma determinada área da empresa, concluindo-se que a adoção de sistemas de custeio mais aprimorados, tal como o ABC, devem fazer parte de programas que busquem o aumento da competitividade do setor florestal.In the current view of globalized industrialization, it has become fundamental to manage essential costs effectively. Conventional programs for reducing costs, do no consider the value agregation grade of routine activities because of the distortion of current accounting systems. This study, presents the main reasons for the lack of relevance of the cost information, commenting on the problem of the reduction of forest waste and its consequences. Using a case study in a company from the forest sector, a simulation of Activity Based Costing (ABC is demonstrated in a determined area of the company it is concluded that the adoption of a more refined cost system, such as the ABC, should be included in programs, that seek to increase the competitiveness of the forest sector.

  17. Developing Entrepreneurial Marketing Mix: Case Study of Entrepreneurial Food Enterprises in Iran

    Directory of Open Access Journals (Sweden)

    Aidin SALAMZADEH

    2011-08-01

    Full Text Available The purpose of this paper is to identify and exam the main elements ofentrepreneurial marketing mix in entrepreneurial enterprises. Our focus in this study is on Iran's top small and medium-size business entrepreneurs in 2007, which possess a brilliant experience aboutentrepreneurial marketing practices. Accordingly, we aim to identify how these enterprises use their previous knowledge and experience to extract elements of marketing mix, which are adjusted in entrepreneurial marketing. As its research framework, this study has used the Quality - Exploratory approach specifically case study according to Ghauri framework. Data were collected from 17 entrepreneurial enterprises. Different methods including indepthand semi-structured interviews, along with open questions fromentrepreneurs and marketing managers were employed in gatheringinformation. Finally, Content analysis method also inductive inference used for data analysis. Results indicate that the Entrepreneurial Marketing Mix include 5Ps which element of Person is a new element among others. However it should be mentioned that there is an entrepreneurial approach in component of Price, Place, Product and Promotions as well and some new component have been added to the conventional marketing mix.

  18. Costs, Benefits and Value Distribution – Ingredients for Successful Cross-Organizational ES Business Cases

    NARCIS (Netherlands)

    Eckartz, Silja M.

    2009-01-01

    This paper introduces my PhD research project on developing guidelines for creating successful business cases for Enterprise System implementations in network settings. Three important aspects that were found to be important in such business cases are: the costs, benefits and the value distribution

  19. Coastal defence cost estimates: Case study of the Netherlands, New Orleans and Vietnam

    NARCIS (Netherlands)

    Hillen, M.M.; Jonkman, S.N.; Kanning, W.; Kok, M.; Geldenhuys, M.A.; Stive, M.J.F.

    2010-01-01

    This study is part of a global study on the costs of adaptation to the effects of climate change. It adds information from three specific case studies (the Netherland, New Orleans and Vietnam) to the global study. The case study areas are comparable by type of coast; all are low-lying deltaic

  20. Teaching Medical Students about Quality and Cost of Care at Case Western Reserve University.

    Science.gov (United States)

    Headrick, Linda A.; And Others

    1992-01-01

    At Case Western University (Ohio), medical students critically analyze the quality and cost of asthma care in the community by studying patients in primary care practices. Each writes a case report, listing all medical charges and comparing them with guidelines for asthma care. Several recommendations for improved care have emerged. (MSE)

  1. #DDOD Use Case: Access to Medicare Part D Drug Event File (PDE) for cost transparency

    Data.gov (United States)

    U.S. Department of Health & Human Services — SUMMARY DDOD use case to request access to Medicare Part D Drug Event File (PDE) for cost transparency to pharmacies and patients. WHAT IS A USE CASE? A “Use Case”...

  2. Proportioning of Steel Fibre Reinforced Concrete Mixes for Pavement Construction and Their Impact on Environment and Cost

    Directory of Open Access Journals (Sweden)

    Stelios Kallis

    2011-07-01

    Full Text Available Steel fibre reinforced concrete (SFRC is a construction material investigated for more than 40 years including for pavement applications. A number of studies have demonstrated the technical merits of SFRC pavements over conventional concrete pavements; however little work has been carried out on the environmental and economical impact of SFRC during the pavement’s life cycle. Therefore, extended research was undertaken within the framework of the EU funded project “EcoLanes” to estimate the environmental and economical loadings of SFRC pavements. The innovative concept of the project is the use of recycled steel tyre-cord wire as concrete fibre reinforcement, which provides additional environmental benefits for tyre recycling over landfilling. Within the project framework a demonstration of a steel-fibre-reinforced roller-compacted concrete (SFR-RCC pavement was constructed in a rural area in Cyprus. In order to assess the economical and environmental picture of the demonstration pavement, life cycle cost analysis (LCCA and life cycle assessment (LCA studies were undertaken, which also compared the under study pavement design with four conventional alternatives. The main output of the studies is that SFR-RCC is more environmentally and economically sustainable than others. In addition, various concrete mix designs were investigated by considering parameters such as fibre type and dosage, cement type, and transportation distances to the construction site. Fibre dosage has been highlighted as a crucial factor compared with economical and environmental loadings in SFR-RCC pavement construction.

  3. Estimate of influenza cases using generalized linear, additive and mixed models.

    Science.gov (United States)

    Oviedo, Manuel; Domínguez, Ángela; Pilar Muñoz, M

    2015-01-01

    We investigated the relationship between reported cases of influenza in Catalonia (Spain). Covariates analyzed were: population, age, data of report of influenza, and health region during 2010-2014 using data obtained from the SISAP program (Institut Catala de la Salut - Generalitat of Catalonia). Reported cases were related with the study of covariates using a descriptive analysis. Generalized Linear Models, Generalized Additive Models and Generalized Additive Mixed Models were used to estimate the evolution of the transmission of influenza. Additive models can estimate non-linear effects of the covariates by smooth functions; and mixed models can estimate data dependence and variability in factor variables using correlations structures and random effects, respectively. The incidence rate of influenza was calculated as the incidence per 100 000 people. The mean rate was 13.75 (range 0-27.5) in the winter months (December, January, February) and 3.38 (range 0-12.57) in the remaining months. Statistical analysis showed that Generalized Additive Mixed Models were better adapted to the temporal evolution of influenza (serial correlation 0.59) than classical linear models.

  4. Modification of the standard enzymatic protocol to a cost-efficient format for mixed-linkage (1¿3, 1¿4)-¿-D-glucan measurement

    Science.gov (United States)

    Abstract The current enzymatic assay approach (AACC Method 32-23) for the measurement of mixed-linkage B-glucan in small grains was modified to a cost-efficient and high throughput format without compromising the accuracy of the results. Ten barley (Hordeum vulgare L.) genotypes used in the study re...

  5. The average cost of measles cases and adverse events following vaccination in industrialised countries

    Directory of Open Access Journals (Sweden)

    Kou Ulla

    2002-09-01

    Full Text Available Abstract Background Even though the annual incidence rate of measles has dramatically decreased in industrialised countries since the implementation of universal immunisation programmes, cases continue to occur in countries where endemic measles transmission has been interrupted and in countries where adequate levels of immunisation coverage have not been maintained. The objective of this study is to develop a model to estimate the average cost per measles case and per adverse event following measles immunisation using the Netherlands (NL, the United Kingdom (UK and Canada as examples. Methods Parameter estimates were based on a review of the published literature. A decision tree was built to represent the complications associated with measles cases and adverse events following imminisation. Monte-Carlo Simulation techniques were used to account for uncertainty. Results From the perspective of society, we estimated the average cost per measles case to be US$276, US$307 and US$254 for the NL, the UK and Canada, respectively, and the average cost of adverse events following immunisation per vaccinee to be US$1.43, US$1.93 and US$1.51 for the NL, UK and Canada, respectively. Conclusions These average cost estimates could be combined with incidence estimates and costs of immunisation programmes to provide estimates of the cost of measles to industrialised countries. Such estimates could be used as a basis to estimate the potential economic gains of global measles eradication.

  6. [A case report of mixed transcortical aphasia due to three attacks of cerebral infarction].

    Science.gov (United States)

    Ibayashi, K; Soma, Y

    1997-04-01

    This is a case report of a 69-year-old right handed male patient with mixed transcortical aphasia caused by the three consecutive strokes in the left hemisphere. The initial attack affected the left occipital region and the second one influenced the angular region of the left parietal lobe. After the second attack the patient showed a symptom similar to transcortical sensory aphasia, although the prognosis was good. The third stroke attacked the subcortical region of the left middle frontal gyrus, consequently the patient became severe mixed transcortical aphasic who could only repeat. Even two years after the last stroke the aphasia was hardly improved. These symptoms are considered to be caused by "functional isolation" of the affected anterior-posterior language areas and the fasciculus arcuatus.

  7. Winsorization on linear mixed model (Case study: National exam of senior high school in West Java)

    Science.gov (United States)

    Yuliyani, Leny; Kurnia, Anang; Indahwati

    2017-03-01

    In the case of hierarchical data is typically modeled with linear mixed model (LMM). The LMM requires the assumption of normality which is error and random effects are assumed normal distribution. However in practice, to meet the assumption of normality is difficult especially if the sample is small. Violation of the normality assumption can be caused by outliers. In this paper, we will examine the effect of outliers on the random effects and error and overcome them with the Winsorization technique. The result of application indicated that Winsorization technique with c-tuning constant iterative process produced root mean squared error, AIC, and BIC are smaller than the others. We conclude that Winsorization technique can be used to overcome outliers in linear mixed model fitting.

  8. Pulmonary mixed squamous cell and glandular papilloma mimicking adenocarcinoma: a case study and literature review.

    Science.gov (United States)

    Lin, Dongliang; Jiang, Yanxia; Wang, Jigang; Ding, Li; Xin, Fangjie; Zhao, Han; Li, Yujun

    2013-08-01

    Mixed squamous cell and glandular papilloma of the lung is an extremely rare benign neoplasm. Here we present another case of mixed squamous cell and glandular papilloma in a 64-year-old female nonsmoker. Histologically, the tumor was composed of mainly papillary structures covered with squamous, glandular and transitional epithelium. Some glandular structures extending into adjacent bronchiolar and alveolar spaces with mucus were similar to adenocarcinoma. Immunohistochemical analysis showed the different kinds of epithelia had similar immunophenotype. The different components were positive for cytokeratin (CK)7, CK19, CAM5.2, CK5/6, CK34βE12, and TTF-1, but negative for CK20. The transitional morphology and immunohistochemistry indicate the different components likely come from a same kind of progenitor in the bronchiolar wall.

  9. Evaluation of operational, economic, and environmental performance of mixed and selective collection of municipal solid waste: Porto case study.

    Science.gov (United States)

    Teixeira, Carlos A; Russo, Mário; Matos, Cristina; Bentes, Isabel

    2014-12-01

    This article describes an accurate methodology for an operational, economic, and environmental assessment of municipal solid waste collection. The proposed methodological tool uses key performance indicators to evaluate independent operational and economic efficiency and performance of municipal solid waste collection practices. These key performance indicators are then used in life cycle inventories and life cycle impact assessment. Finally, the life cycle assessment environmental profiles provide the environmental assessment. We also report a successful application of this tool through a case study in the Portuguese city of Porto. Preliminary results demonstrate the applicability of the methodological tool to real cases. Some of the findings focus a significant difference between average mixed and selective collection effective distance (2.14 km t(-1); 16.12 km t(-1)), fuel consumption (3.96 L t(-1); 15.37 L t(-1)), crew productivity (0.98 t h(-1) worker(-1); 0.23 t h(-1) worker(-1)), cost (45.90 € t(-1); 241.20 € t(-1)), and global warming impact (19.95 kg CO2eq t(-1); 57.47 kg CO2eq t(-1)). Preliminary results consistently indicate: (a) higher global performance of mixed collection as compared with selective collection; (b) dependency of collection performance, even in urban areas, on the waste generation rate and density; (c) the decline of selective collection performances with decreasing source-separated material density and recycling collection rate; and (d) that the main threats to collection route efficiency are the extensive collection distances, high fuel consumption vehicles, and reduced crew productivity.

  10. Mixed-ability secondary science in one urban school district: A multiple case study

    Science.gov (United States)

    Tworek, Francis A.

    The standards and accountability movements demand that all students be given the opportunity to learn more science than ever before. However, there is much uncertainty about how educators should proceed with this task. Issues of concern include achievement gaps, tracking, and graduation requirements. The purpose of this multiple case study was to explore the challenges identified by four secondary science teachers in one urban public school district as they taught classes that included students representing a wide range of abilities and prior academic success. These mixed-ability science classes were generally defined as science classes which are required for high school graduation but which have no academic prerequisites. The central research questions in this qualitative study were: (1) How do secondary science teachers describe the challenges they face while teaching a mixed-ability science course required for graduation when the course has no prerequisites; and (2) What strategies do they use to deal with these challenges? Data collection was confined to four cases within one Midwest urban school district during the 2004-2005 school year. Each case involved one class taught by an individual teacher. One case was an 8th grade science class at a middle school. The other three cases represented three district-required courses in three different high schools: 9th grade biology, 10th grade chemistry, and 11th grade physics. Data sources included interviews with the teachers, observations in their classrooms, district achievement and demographic data, and school documents. Three themes emerged from the cross-case analysis: (1) a sense of belonging; (2) the teacher's focus; and (3) successful learning. The final chapter discusses the implications of these themes and makes recommendations for further study.

  11. A Fibroid or Cancer? A Rare Case of Mixed Choriocarcinoma and Epithelioid Trophoblastic Tumour

    Directory of Open Access Journals (Sweden)

    Wan Yu Luk

    2013-01-01

    Full Text Available Background. Gestational trophoblastic disease (GTD is a rare complication of pregnancy which is characterised by abnormal growth of the trophoblasts at the placental site. It is categorised into benign and malignant forms, which include hydatidiform moles (HMs and gestational trophoblastic neoplasia (GTN, respectively. A mixed choriocarcinoma (CC and epithelioid trophoblastic tumour (ETT is an extremely rare subgroup of GTN, which is a highly curable but aggressive form of malignancy. Case. We report a case of mixed CC and ETT in a 41-year-old patient who presented with a 2-year history of menorrhagia and fibroid uterus in the absence of previous history of molar pregnancy. She had a 12-year interval between the antecedent pregnancy and presentation. She was treated with intensive regimen of adjuvant chemotherapy, etoposide, methotrexate, and actinomycin-D with etoposide and cisplatin (EMA-EP. She has remained disease free for more than 5 years. Conclusion. This case highlights the importance of considering GTN as one of the differential diagnoses value of β-HCG in patients presented with menorrhagia and growing fibroids.

  12. Estimating the indirect costs associated with the expected number of cancer cases in Mexico by 2020

    OpenAIRE

    Cristina Gutiérrez-Delgado; Daniel Armas-Texta; Nancy Reynoso-Noverón; Abelardo Meneses-García; Alejandro Mohar-Betancourt

    2016-01-01

    Objective. To estimate the indirect costs generated by adults with cancer in Mexico from 2002-2020. Materials and methods. Using information from national sources and the national cancer incidence from GLOBOCAN, we estimated income lost due to premature death (ILPD), short-term benefits (STBs), disability pensions (DPs), and opportunity costs for the carer (OCCs) generated by patients with cancer. Amounts were reported in Mexican pesos. Results. We estimated 23 359 deaths and 216 679 new case...

  13. Estimating the indirect costs associated with the expected number of cancer cases in Mexico by 2020.

    Science.gov (United States)

    Gutiérrez-Delgado, Cristina; Armas-Texta, Daniel; Reynoso-Noverón, Nancy; Meneses-García, Abelardo; Mohar-Betancourt, Alejandro

    2016-04-01

    To estimate the indirect costs generated by adults with cancer in Mexico from 2002-2020. Using information from national sources and the national cancer incidence from GLOBOCAN, we estimated income lost due to premature death (ILPD), short-term benefits (STBs), disability pensions (DPs), and opportunity costs for the carer (OCCs) generated by patients with cancer. Amounts were reported in Mexican pesos. We estimated 23 359 deaths and 216 679 new cases of cancer by 2020, which would be associated with a total indirect cost of 20.15 billion Mexican pesos. Men are expected to generate 54.9% of these costs. ILPD is expected to comprise the highest percentage of the cost (60%), followed by OCCs (22%), STBs (17%) and DPs (1%). From an economic perspective, the results emphasize the need to strengthen preventive interventions and early detection of cancer among adults to reduce its effect on the productivity of Mexico.

  14. Manufacturing cost reductions and ecoefficiency: a relationship based on a case study

    Directory of Open Access Journals (Sweden)

    Rosangela Maria Vanalle

    2014-12-01

    Full Text Available In the search for higher profits or competitiveness, firms have frequently used structured procedures to reduce their costs and expenses. However, the environmental consequences associated to those processes have hardly been considered. Hence, the central purpose of this paper is to show that it is possible to obtain relevant environmental gains even not considering the environmental issues as part of the operational cost reduction efforts. This particular point was verified through a single case study where value analysis was used to obtain manufacturing cost reductions in a company belonging to the Brazilian textile sector. Even not considering environmental aspects as part of the value analysis procedures, when the cost reduction actions were implemented it was possible to confirm that they also brought significant improvements to the environmental conditions, which were measured by the firm ecoefficiency levels before and after the cost reduction implementations. Normal 0 21 false false false PT-BR X-NONE X-NONE

  15. IMPROVED ERROR ESTIMATES FOR MIXED FINITE ELEMENT FOR NONLINEAR HYPERBOLIC EQUATIONS: THE CONTINUOUS-TIME CASE

    Institute of Scientific and Technical Information of China (English)

    Yan-ping Chen; Yun-qing Huang

    2001-01-01

    Improved L2-error estimates are computed for mixed finite element methods for second order nonlinear hyperbolic equations. Results are given for the continuous-time case. The convergence of the values for both the scalar function and the flux is demonstrated. The technique used here covers the lowest-order Raviart-Thomas spaces, as well as the higherorder spaces. A second paper will present the analysis of a fully discrete scheme (Numer.Math. J. Chinese Univ. vol.9, no.2, 2000, 181-192).

  16. Delusional Parasitosis in a Female Treated with Mixed Amphetamine Salts: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Martha Buscarino

    2012-01-01

    Full Text Available Objectives. To explore factors underlying the onset of delusional parasitosis; a condition in which an individual has a fixed, false belief that he/she is infested with insects. Case Description. MJ is a 57-year-old female who presents with symptoms of fatigue and AD/HD. Upon treatment with extended release mixed amphetamine salts, the patient displayed symptoms of delusional parasitosis. After eventual discontinuation of this medication, her delusions resolved. Comments. In order to maintain confidentiality, all identifying information was removed. To this end, please note that MJ is a fictitious name.

  17. User cost of Caesarean section: case study of Bunia, Democratic Republic of Congo.

    Science.gov (United States)

    Deboutte, Danielle; O'Dempsey, Tim; Mann, Gillian; Faragher, Brian

    2015-01-01

    The study estimated the user cost of Caesarean section (CS), a major component of emergency obstetric care (EmOC), in a post conflict situation in Bunia, DR Congo, 2008. A case control study used a structured questionnaire to compare women who had a CS (cases) with women who had a vaginal delivery (controls). Service information was recorded in 20 facilities providing obstetric care. Maternal and perinatal deaths, including those outside health facilities, were recorded and verified. The user cost of CS was estimated at four hospitals, one of them managed by an international non-governmental organization offering EmOC free of charge, compared to the user cost of women who had a vaginal delivery. Among paying users, the mean healthcare cost was $US68.0 for CS and $US12.1 for vaginal delivery; mean transport cost to and from the hospital was $US11.7 for cases and $US3.2 for controls. The mean monthly family income was $US75.5. The user cost of CS placed an important financial burden on patients and their families. During transition from humanitarian to developmental assistance, donors and the State should shore up the EmOC budget to avoid an increase in maternal and perinatal mortality.

  18. [Process-oriented cost calculation in interventional radiology. A case study].

    Science.gov (United States)

    Mahnken, A H; Bruners, P; Günther, R W; Rasche, C

    2012-01-01

    Currently used costing methods such as cost centre accounting do not sufficiently reflect the process-based resource utilization in medicine. The goal of this study was to establish a process-oriented cost assessment of percutaneous radiofrequency (RF) ablation of liver and lung metastases. In each of 15 patients a detailed task analysis of the primary process of hepatic and pulmonary RF ablation was performed. Based on these data a dedicated cost calculation model was developed for each primary process. The costs of each process were computed and compared with the revenue for in-patients according to the German diagnosis-related groups (DRG) system 2010. The RF ablation of liver metastases in patients without relevant comorbidities and a low patient complexity level results in a loss of EUR 588.44, whereas the treatment of patients with a higher complexity level yields an acceptable profit. The treatment of pulmonary metastases is profitable even in cases of additional expenses due to complications. Process-oriented costing provides relevant information that is needed for understanding the economic impact of treatment decisions. It is well suited as a starting point for economically driven process optimization and reengineering. Under the terms of the German DRG 2010 system percutaneous RF ablation of lung metastases is economically reasonable, while RF ablation of liver metastases in cases of low patient complexity levels does not cover the costs.

  19. Direct Cost of Reprocessing Cotton-woven Surgical Drapes: a Case Study

    Directory of Open Access Journals (Sweden)

    Mariana Fexina Tomé

    2015-06-01

    Full Text Available OBJECTIVE Identify the direct cost of reprocessing double and single cotton-woven drapes of the surgical LAP package. METHOD A quantitative, exploratory and descriptive case study, performed at a teaching hospital. The direct cost of reprocessing cotton-woven surgical drapes was calculated by multiplying the time spent by professionals involved in reprocessing the unit with the direct cost of labor, adding to the cost of materials. The Brazilian currency (R$ originally used for the calculations was converted to US currency at the rate of US$0.42/R$. RESULTS The average total cost for surgical LAP package was US$9.72, with the predominance being in the cost of materials (US$8.70 or 89.65%. It is noteworthy that the average total cost of materials was mostly impacted by the cost of the cotton-woven drapes (US$7.99 or 91.90%. CONCLUSION The knowledge gained will subsidize discussions about replacing reusable cotton-woven surgical drapes for disposable ones, favoring arguments regarding the advantages and disadvantages of this possibility considering human resources, materials, as well as structural, environmental and financial resources.

  20. Marginal costs of water savings from cooling system retrofits: a case study for Texas power plants

    Science.gov (United States)

    Loew, Aviva; Jaramillo, Paulina; Zhai, Haibo

    2016-10-01

    The water demands of power plant cooling systems may strain water supply and make power generation vulnerable to water scarcity. Cooling systems range in their rates of water use, capital investment, and annual costs. Using Texas as a case study, we examined the cost of retrofitting existing coal and natural gas combined-cycle (NGCC) power plants with alternative cooling systems, either wet recirculating towers or air-cooled condensers for dry cooling. We applied a power plant assessment tool to model existing power plants in terms of their key plant attributes and site-specific meteorological conditions and then estimated operation characteristics of retrofitted plants and retrofit costs. We determined the anticipated annual reductions in water withdrawals and the cost-per-gallon of water saved by retrofits in both deterministic and probabilistic forms. The results demonstrate that replacing once-through cooling at coal-fired power plants with wet recirculating towers has the lowest cost per reduced water withdrawals, on average. The average marginal cost of water withdrawal savings for dry-cooling retrofits at coal-fired plants is approximately 0.68 cents per gallon, while the marginal recirculating retrofit cost is 0.008 cents per gallon. For NGCC plants, the average marginal costs of water withdrawal savings for dry-cooling and recirculating towers are 1.78 and 0.037 cents per gallon, respectively.

  1. The National Program of Cancer Registries: Explaining State Variations in Average Cost per Case Reported

    Directory of Open Access Journals (Sweden)

    Hannah K. Weir, PhD

    2005-07-01

    Full Text Available Introduction The Centers for Disease Control and Prevention’s National Program of Cancer Registries is a federally funded surveillance program that provides support and assistance to state and territorial health departments for the operation of cancer registries. The objective of this study was to identify factors associated with the Centers for Disease Control and Prevention’s costs to report cancer cases during the first 5 years of the National Program of Cancer Registries. Methods Information on expenditures and number of cases reported through the National Program of Cancer Registries was used to estimate the average cost per case reported for each state program. Additional information was obtained from other sources, and regression analyses were used to assess the contribution of each factor. Results Average costs of the National Program of Cancer Registries differed substantially among programs and were inversely associated with the number of cases reported (P < .001. The geographic area of the state was positively associated with the cost (P = .01, as was the regional cost of living (P = .08, whereas the program type (i.e., enhancement or planning was inversely associated with cost (P = .08. Conclusion The apparent existence of economies of scale suggests that contiguous state programs might benefit from sharing infrastructure and other fixed costs, such as database management resources, depending on the geographic area and population size served. Sharing database management resources might also promote uniform data collection and quality control practices, reduce the information-sharing burden among states, and allow more resources to be used for other cancer prevention and control activities.

  2. Mixed Fungal Infection in Early Period after Kidney Transplantation: A Case Report

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    Emel IŞIKTAŞ SAYILAR

    2015-09-01

    Full Text Available Invasive fungal infections have a rapid and frequently fatal course in patients with solid organ transplantations. Mostly Aspergillus spp., Mucorales spp., Candida spp. and Cryptococcus neoformans are causal pathogens for opportunistic infections. Aspergillus spp. and Mucorales spp. especially lead to invasive fungal infections at rhino-cerebral area; they show similar radiological and clinical signs and they lead to invasive fungal co-infections. In case of any doubt about invasive fungal infections, antifungal treatment should be initiated as soon as possible and immunosuppressive treatment should be considered. This case presentation is about a patient at 51 years of age who developed invasive rhinocerebral mixed fungal infection in 4 weeks following renal transplant.

  3. Diagnostic dilemma in a case of malignant mixed mullerian tumor of the cervix

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    Wuntkal Rekha

    2006-07-01

    Full Text Available Abstract Background Malignant mixed mullerian tumors (MMMT are rare biphasic malignant neoplasm. The commonest site of their occurrence in female genital tract is body of the uterus. MMMT of the cervix is extremely rare. Case presentation We report the clinical, pathological and immunohistochemical profile and diagnostic difficulties in a case of giant MMMT of the cervix in a postmenopausal woman who presented with a large cervical mass. On microscopic examination, initially tumor appeared to be endometrial stromal sarcoma, however, immunohistochemical examination revealed the biphasic nature of the tumor. The malignant epithelial component was basaloid squamous carcinoma with homologous sarcomatous component. The patient was treated with surgery. However, she experienced vaginal vault recurrence four months after the initial treatment, which was successfully treated with pelvic radiotherapy. Conclusion Accurate diagnosis of cervical MMMT is important for appropriate treatment of the patient.

  4. Ovarian malignant mixed mullerian tumor with primitive neuroectodermal differentiation: case report with review of the literature.

    Science.gov (United States)

    Nasser, Haitham; Morris, Robert T; Fathallah, Lamia

    2011-03-15

    Ovarian malignant mixed mullarian tumor (OMMMT) is a rare and aggressive tumor of the female genital tract, occurring mainly in elderly women. Stage of disease is the most important predictor for survival with no prognostic effect, yet, of heterologous elements. Rare case reports described the peculiar presence of primitive neuroectodermal tissue among other heterologous elements in these tumors. Attractive designations, such as teratoid carcinosarcoma, were set by some authors to describe this subset of lesions, where it was considered a primary neuroectodermal tumor capable of multilineage differentiation. We here report a case of OMMMT in an elderly woman with focal primitive neuroectodermal differentiation as the sole heterologous element, and review the controversy on this topic in the literature.

  5. Primitive neuroectodermal tumor in a mixed germ cell tumor - A rare case report

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    Khushboo Dewan

    2015-01-01

    Full Text Available A rare case of testicular tumor in a 20-year-old male with Primitive Neuroectodermal Tumor (PNET was reported. Imaging studies showed a large heterogenous mass in the right scrotal sac and a large retroperitoneal mass with metastasis in the lung and liver. Serum alpha fetoprotein (AFP was markedly elevated with moderate increase in serum β-human chorionic gonadotropin (hCG levels. After orchidectomy, a histological diagnosis of mixed germ cell tumor-teratoma with primitive neuroectodermal, embryonal, and yolk sac components was made. Some scattered embryoid bodies representative of primitive germ cell tumor were also present. Morphological diversity including PNET prompted the authors to report this case as PNET points toward a poor prognosis.

  6. Uterine horn aplasia with complications in two mixed-breed bitches : case report

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    M.L. Schulman

    1997-07-01

    Full Text Available Unilateral segmental uterine horn aplasia was found in 2 mixed-breed bitches. The 1st bitch was presented with clinical signs of acute abdominal pain, and pyometra was suspected. Pyometra was confirmed surgically with rupture of a blind-ending cranial portion of the anomalous right uterine horn, which had resulted in peritonitis. The 2nd bitch was presented for routine ovariohysterectomy. The right uterine horn was affected by segmental aplasia, with mucometra of the cranial portion of the affected horn. Histopathology demonstrated both uteri to have diffuse cystic endometrial hyperplasia. It is postulated that cystic endometrial hyperplasia, together with the congenital anomaly, resulted in pyometra in one case and in mucometra in the other case. This is believed to be the 1st report of uterine horn aplasia in the bitch in association with clinical signs and lesions other than infertility.

  7. A Case of ANCA Negative Pauci-immune Crescentic Glomerulonephritis in Mixed Connective Tissue Disease

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    Neena Mampilly

    2015-04-01

    Full Text Available Pauci-immune crescentic glomerulonephritis (CrGN is one of the most common causes of rapidly progressive glomerulonephritis. The majority of patients with pauciimmune CrGN have circulating antineutrophil cytoplasmic autoantibodies (ANCA. Approximately 10% of systemic vasculitides patients test negative for ANCA. Majority of the ANCA negative pauciimmune CrGN described in the literature have not shown associations with connective tissue diseases. Only isolated case reports of associations with systemic lupus erythematosus and scleroderma have been described. We report the case of a 24 yr lady who was diagnosed to have a pauciimmune crescentic glomerulonephritis on renal biopsy, and was found to be ANCA negative. Subsequently her collagen profile revealed a mixed connective tissue disease, even though she did not have any other systemic manifestations of the disease at presentation. We presume that antiendothelial antibodies (AECA may have a role in the pathogenesis of the disease.

  8. Equipment Design and Cost Estimation for Small Modular Biomass Systems, Synthesis Gas Cleanup, and Oxygen Separation Equipment; Task 9: Mixed Alcohols From Syngas -- State of Technology

    Energy Technology Data Exchange (ETDEWEB)

    Nexant Inc.

    2006-05-01

    This deliverable is for Task 9, Mixed Alcohols from Syngas: State of Technology, as part of National Renewable Energy Laboratory (NREL) Award ACO-5-44027, ''Equipment Design and Cost Estimation for Small Modular Biomass Systems, Synthesis Gas Cleanup and Oxygen Separation Equipment''. Task 9 supplements the work previously done by NREL in the mixed alcohols section of the 2003 technical report Preliminary Screening--Technical and Economic Assessment of Synthesis Gas to Fuels and Chemicals with Emphasis on the Potential for Biomass-Derived Syngas.

  9. Mixed plastics recycling technology

    CERN Document Server

    Hegberg, Bruce

    1995-01-01

    Presents an overview of mixed plastics recycling technology. In addition, it characterizes mixed plastics wastes and describes collection methods, costs, and markets for reprocessed plastics products.

  10. Use of functioning-disability and dependency for case-mix and subtyping of schizophrenia

    Directory of Open Access Journals (Sweden)

    Susana Ochoa

    2012-03-01

    Full Text Available Background and Objectives: To evaluate the utility of the constructs functioning and disability (F & D and dependency for case-mix and subtyping of patients with schizophrenia by psychosocial, clinical, use of services and attention received from informal carers. Methods: A randomly selected total of 205 people with schizophrenia, and their careers were evaluated through PANSS, DAS-sv, Objective and Subjective Burden Scale (ECFOS-II and use of services. Results: Two groups and Four profiles were identified according to levels of Dependency: The non-dependent group was made of two profiles: independent (I, and persons with disability in the community (DiC. The dependent group included persons with dependency in the community (DeC and persons with dependency in hospital care (DeH. There are clinical and psychosocial differences between these profiles being the dependent the most severe. Regarding use of services, DeC use the most resources, with the exception DeH (more hospitalization resources. The DeC profile generate greater family burden in the following areas; taking medication, being accompanied to appointments, and management than the DiC, despite both groups showing a high need for support. Conclusions: Dependency is a relevant construct for case-mix and subtyping in schizophrenia, and it is related to severity both at the social and clinical level. DeC generate more family burden than the other profiles, followed by DiC (patients with schizophrenia with disability but non-dependent.

  11. Generalized linear mixed models for multi-reader multi-case studies of diagnostic tests.

    Science.gov (United States)

    Liu, Wei; Pantoja-Galicia, Norberto; Zhang, Bo; Kotz, Richard M; Pennello, Gene; Zhang, Hui; Jacob, Jessie; Zhang, Zhiwei

    2017-06-01

    Diagnostic tests are often compared in multi-reader multi-case (MRMC) studies in which a number of cases (subjects with or without the disease in question) are examined by several readers using all tests to be compared. One of the commonly used methods for analyzing MRMC data is the Obuchowski-Rockette (OR) method, which assumes that the true area under the receiver operating characteristic curve (AUC) for each combination of reader and test follows a linear mixed model with fixed effects for test and random effects for reader and the reader-test interaction. This article proposes generalized linear mixed models which generalize the OR model by incorporating a range-appropriate link function that constrains the true AUCs to the unit interval. The proposed models can be estimated by maximizing a pseudo-likelihood based on the approximate normality of AUC estimates. A Monte Carlo expectation-maximization algorithm can be used to maximize the pseudo-likelihood, and a non-parametric bootstrap procedure can be used for inference. The proposed method is evaluated in a simulation study and applied to an MRMC study of breast cancer detection.

  12. Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy

    Directory of Open Access Journals (Sweden)

    Torbica Aleksandra

    2010-05-01

    Full Text Available Abstract Objectives The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass infusion containers. Methods A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases and patients without CLABSI (controls were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days associated with the two infusion containers. Results A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143; 56% of the cases and 57% of the controls were females (p = 0.922. The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p Conclusions CLABSI results in considerable and significant increase in utilization of hospital resources. Use of innovative technologies such as closed infusion containers can significantly reduce the incidence of healthcare acquired infection without posing additional burden on hospital budgets.

  13. Robotic partial nephrectomy - Evaluation of the impact of case mix on the procedural learning curve.

    Science.gov (United States)

    Roman, A; Ahmed, K; Challacombe, B

    2016-05-01

    Although Robotic partial nephrectomy (RPN) is an emerging technique for the management of small renal masses, this approach is technically demanding. To date, there is limited data on the nature and progression of the learning curve in RPN. To analyse the impact of case mix on the RPN LC and to model the learning curve. The records of the first 100 RPN performed, were analysed at our institution that were carried out by a single surgeon (B.C) (June 2010-December 2013). Cases were split based on their Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score into the following groups: 6-7, 8-9 and >10. Using a split group (20 patients in each group) and incremental analysis, the mean, the curve of best fit and R(2) values were calculated for each group. Of 100 patients (F:28, M:72), the mean age was 56.4 ± 11.9 years. The number of patients in each PADUA score groups: 6-7, 8-9 and >10 were 61, 32 and 7 respectively. An increase in incidence of more complex cases throughout the cohort was evident within the 8-9 group (2010: 1 case, 2013: 16 cases). The learning process did not significantly affect the proxies used to assess surgical proficiency in this study (operative time and warm ischaemia time). Case difficulty is an important parameter that should be considered when evaluating procedural learning curves. There is not one well fitting model that can be used to model the learning curve. With increasing experience, clinicians tend to operate on more difficult cases. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  14. 26 CFR 1.263(c)-1 - Intangible drilling and development costs in the case of oil and gas wells.

    Science.gov (United States)

    2010-04-01

    ... Intangible drilling and development costs in the case of oil and gas wells. For rules relating to the option to deduct as expenses intangible drilling and development costs in the case of oil and gas wells, see... case of oil and gas wells. 1.263(c)-1 Section 1.263(c)-1 Internal Revenue INTERNAL REVENUE...

  15. Improving Library Management by Using Cost Analysis Tools: A Case Study for Cataloguing Processes

    Directory of Open Access Journals (Sweden)

    Lorena Siguenza-Guzman

    2014-02-01

    Full Text Available TTDABC is a relatively new costing management technique, initially developed for manufacturing processes, which is gaining attention in libraries. This is because TDABC is a fast and simple method that only requires two parameters, an estimation of time required to perform an activity and the unit cost per time of supplying capacity. A few case studies have been documented with regard to TDABC in libraries; all of them being oriented to analyse specific library activities such as inter-library loan, acquisition and circulation processes. The primary focus of this paper is to describe TDABC implementation in one of the most important library processes, namely cataloguing. In particular, original and copy cataloguing are analysed through a case study to demonstrate the applicability and usefulness of TDABC to perform cost analysis of cataloguing processes.

  16. A case-based reasoning approach for estimating the costs of pump station projects

    Directory of Open Access Journals (Sweden)

    Mohamed M. Marzouk

    2011-10-01

    Full Text Available The effective estimation of costs is crucial to the success of construction projects. Cost estimates are used to evaluate, approve and/or fund projects. Organizations use some form of classification system to identify the various types of estimates that may be prepared during the lifecycle of a project. This research presents a parametric-cost model for pump station projects. Fourteen factors have been identified as important to the influence of the cost of pump station projects. A data set that consists of forty-four pump station projects (fifteen water and twenty-nine waste water are collected to build a Case-Based Reasoning (CBR library and to test its performance. The results obtained from the CBR tool are processed and adopted to improve the accuracy of the results. A numerical example is presented to demonstrate the development of the effectiveness of the tool.

  17. OPTIMIZATION METHOD AND SOFTWARE FOR FUEL COST REDUCTION IN CASE OF ROAD TRANSPORT ACTIVITY

    Directory of Open Access Journals (Sweden)

    György Kovács

    2017-06-01

    Full Text Available The transport activity is one of the most expensive processes in the supply chain and the fuel cost is the highest cost among the cost components of transportation. The goal of the research is to optimize the transport costs in case of a given transport task both by the selecting the optimal petrol station and by determining the optimal amount of the refilled fuel. Recently, in practice, these two decisions have not been made centrally at the forwarding company, but they depend on the individual decision of the driver. The aim of this study is to elaborate a precise and reliable mathematical method for selecting the optimal refuelling stations and determining the optimal amount of the refilled fuel to fulfil the transport demands. Based on the elaborated model, new decision-supporting software is developed for the economical fulfilment of transport trips.

  18. From productivity strategy to business case : Choosing a cost-effective intervention for workplace innovations

    NARCIS (Netherlands)

    Oeij, P.R.A.; Looze, M.P. de; Have, K. ten; Rhijn, J.W. van; Graaf, H.A.L.M. de

    2012-01-01

    The article presents an approach to developing cost-effective interventions for workplace innovations for entrepreneurs who seek to enhance the productivity of an organization. The business case method is used to extend the Q4-model of productivity, which supports developing a productivity strategy

  19. Answering the Call for Accountability: An Activity and Cost Analysis Case Study

    Science.gov (United States)

    Carducci, Rozana; Kisker, Carrie B.; Chang, June; Schirmer, James

    2007-01-01

    This article summarizes the findings of a case study on the creation and application of an activity-based cost accounting model that links community college salary expenditures to mission-critical practices within academic divisions of a southern California community college. Although initially applied as a financial management tool in private…

  20. Costs and benefits of biological control of invasive alien plants: case studies from South Africa

    CSIR Research Space (South Africa)

    Van Wilgen, BW

    2004-01-01

    Full Text Available . In many cases, plants are brought under complete control. In this paper, we describe an attempt to estimate the costs and benefits of the biological control of 6 weed species (Opuntia, aurantiaca, Sesbania punicea, Lantana camara, Acacia longifolia, A...

  1. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    Directory of Open Access Journals (Sweden)

    Alam Khurshid

    2010-06-01

    Full Text Available Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC, a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG targets the financial sustainability of such facilities is crucial. Methods The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value. Sensitivity analysis was done using 3% discount rate. Results The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient. Conclusion The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase

  2. Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study.

    Science.gov (United States)

    Tremblay, Dominique; Touati, Nassera; Roberge, Danièle; Breton, Mylaine; Roch, Geneviève; Denis, Jean-Louis; Candas, Bernard; Francoeur, Danièle

    2016-03-21

    Managed cancer networks are widely promoted in national cancer control programs as an organizational form that enables integrated care as well as enhanced patient outcomes. While national programs are set by policy-makers, the detailed implementation of networks is delegated at the service delivery and institutional levels. It is likely that the capacity to ensure more integrated cancer services requires multi-level governance processes responsive to the strengths and limitations of the contexts and capable of supporting network-based working. Based on an empirical case, this study aims to analyze the implementation of a mandated cancer network, focusing on governance and health services integration as core concepts in the study. This nested multi-case study uses mixed methods to explore the implementation of a mandated cancer network in Quebec, a province of Canada. The case is the National Cancer Network (NCN) subdivided into three micro-cases, each defined by the geographic territory of a health and social services region. For each region, two local health services centers (LHSCs) are selected based on their differences with respect to determining characteristics. Qualitative data will be collected from various sources using three strategies: review of documents, focus groups, and semi-directed interviews with stakeholders. The qualitative data will be supplemented with a survey that will measure the degree of integration as a proxy for implementation of the NCN. A score will be constructed, and then triangulated with the qualitative data, which will have been subjected to content analysis. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify governance patterns similarities and differences and degree of integration in contexts. This study is designed to inform decision-making to develop more effective network implementation strategies by thoroughly describing multi-level governance processes of a

  3. A cost-effective strategy for the bio-prospecting of mixed microalgae with high carbohydrate content: diversity fluctuations in different growth media.

    Science.gov (United States)

    Cea-Barcia, Glenda; Buitrón, Germán; Moreno, Gloria; Kumar, Gopalakrishnan

    2014-07-01

    In recent years, widespread efforts have been directed towards decreasing the costs associated with microalgae culture systems for the production of biofuels. In this study, a simple and inexpensive strategy to bio-prospect and cultivate mixed indigenous chlorophytes with a high carbohydrate content for biomethane and biohydrogen production was developed. Mixed microalgae were collected from four different water-bodies in Queretaro, Mexico, and were grown in Bold's basal mineral medium and secondary effluent from a wastewater treatment plant using inexpensive photo-bioreactors. The results showed large fluctuations in microalgal genera diversity based on different culture media and nitrogen sources. In secondary effluent, Golenkinia sp. and Scenedesmus sp. proliferated. The carbohydrate content, for secondary effluent, varied between 12% and 57%, and the highest volumetric and areal productivity were 61 mg L(-1)d(-1) and 4.6 g m(-2)d(-1), respectively. These results indicate that mixed microalgae are a good feedstock for biomethane and biohydrogen production.

  4. Performance of a low cost interdigitated flow design on a 1 kW class all vanadium mixed acid redox flow battery

    Energy Technology Data Exchange (ETDEWEB)

    Reed, David; Thomsen, Edwin; Li, Bin; Wang, Wei; Nie, Zimin; Koeppel, Brian; Sprenkle, Vincent

    2016-02-01

    Three flow designs were operated in a 3-cell 1 kW class all vanadium mixed acid redox flow battery. The influence of electrode surface area and flow rate on the coulombic, voltage, and energy efficiency and the pressure drop in the flow circuit will be discussed and correlated to the flow design. Material cost associated with each flow design will also be discussed.

  5. Performance of a low cost interdigitated flow design on a 1 kW class all vanadium mixed acid redox flow battery

    Science.gov (United States)

    Reed, David; Thomsen, Edwin; Li, Bin; Wang, Wei; Nie, Zimin; Koeppel, Brian; Sprenkle, Vincent

    2016-02-01

    Three flow designs were operated in a 3-cell 1 kW class all vanadium mixed acid redox flow battery. The influence of electrode surface area and flow rate on the coulombic, voltage, and energy efficiency and the pressure drop in the flow circuit will be discussed and correlated to the flow design. Material cost associated with each flow design will also be discussed.

  6. Difficult-to-heal wounds of mixed arterial/venous and venous etiology: a cost-effectiveness analysis of extracellular matrix

    Directory of Open Access Journals (Sweden)

    Romanelli M

    2016-05-01

    Full Text Available Marco Romanelli,1 Adrienne M Gilligan,2,3 Curtis R Waycaster,3,4 Valentina Dini1 1Department of Dermatology, University of Pisa, Pisa, Italy; 2Department of Life Sciences, Truven Health Analytics, Fort Worth, TX, USA; 3Department of Pharmacotherapy, University of North Texas Health Sciences Center, Fort Worth, TX, USA; 4Department of Market Access, Smith and Nephew Inc., Fort Worth, TX, USA Importance: Difficult-to-heal wounds pose clinical and economic challenges, and cost-effective treatment options are needed. Objective: The aim of this study is to determine the cost-effectiveness of extracellular matrix (ECM relative to standard of care (SC on wound closure for the treatment of mixed arterial/venous (A/V or venous leg ulcers (VLUs. Design, setting, and participants: A two-stage Markov model was used to predict the expected costs and outcomes of wound closure for ECM and SC. Outcome data used in the analysis were taken from an 8-week randomized clinical trial that directly compared ECM and SC. Patients were followed up for an additional 6 months to assess wound closure. Forty-eight patients completed the study; 25 for ECM and 23 for SC. SC was defined as a standard moist wound dressing. Transition probabilities for the Markov states were estimated from the clinical trial. Main outcomes and measures: The economic outcome of interest was direct cost per closed-wound week. Resource utilization was based on the treatment regimen used in the clinical trial. Costs were derived from standard cost references. The payer’s perspective was taken. Results: ECM-treated wounds closed, on average, after 5.4 weeks of treatment, compared with 8.3 weeks for SC wounds (P=0.02. Furthermore, complete wound closure was significantly higher in patients treated with ECM (P<0.05, with 20 wounds closed in the ECM group (80% and 15 wounds closed in the SC group (65%. After 8 months, patients treated with ECM had substantially higher closed-wound weeks compared with

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

    Science.gov (United States)

    Kolbasovsky, Andrew; Reich, Leonard; Meyerkopf, Neil

    2010-01-01

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

  8. Adaptation costs for climate change-related cases of diarrhoeal disease, malnutrition, and malaria in 2030

    Science.gov (United States)

    Ebi, Kristie L

    2008-01-01

    Background Climate change has begun to negatively affect human health, with larger burdens projected in the future as weather patterns continue to change. The climate change-related health consequences of diarrhoeal diseases, malnutrition, and malaria are projected to pose the largest risks to future populations. Limited work has been done to estimate the costs of adapting to these additional health burdens. Methods The costs of treating diarrhoeal diseases, malnutrition (stunting and wasting only), and malaria in 2030 were estimated under three climate scenarios using (1) the current numbers of cases; (2) the projected relative risks of these diseases in 2030; and (3) current treatment costs. The analysis assumed that the number of annual cases and costs of treatment would remain constant. There was limited consideration of socioeconomic development. Results Under a scenario assuming emissions reductions resulting in stabilization at 750 ppm CO2 equivalent in 2210, the costs of treating diarrhoeal diseases, malnutrition, and malaria in 2030 were estimated to be $4 to 12 billion. This is almost as much as current total annual overseas development assistance for health. Conclusion The investment needs in the health sector to address climate-sensitive health outcomes are large. Additional human and financial resources will be needed to prevent and control the projected increased burden of health outcomes due to climate change. PMID:18803827

  9. Adaptation costs for climate change-related cases of diarrhoeal disease, malnutrition, and malaria in 2030

    Directory of Open Access Journals (Sweden)

    Ebi Kristie L

    2008-09-01

    Full Text Available Abstract Background Climate change has begun to negatively affect human health, with larger burdens projected in the future as weather patterns continue to change. The climate change-related health consequences of diarrhoeal diseases, malnutrition, and malaria are projected to pose the largest risks to future populations. Limited work has been done to estimate the costs of adapting to these additional health burdens. Methods The costs of treating diarrhoeal diseases, malnutrition (stunting and wasting only, and malaria in 2030 were estimated under three climate scenarios using (1 the current numbers of cases; (2 the projected relative risks of these diseases in 2030; and (3 current treatment costs. The analysis assumed that the number of annual cases and costs of treatment would remain constant. There was limited consideration of socioeconomic development. Results Under a scenario assuming emissions reductions resulting in stabilization at 750 ppm CO2 equivalent in 2210, the costs of treating diarrhoeal diseases, malnutrition, and malaria in 2030 were estimated to be $4 to 12 billion. This is almost as much as current total annual overseas development assistance for health. Conclusion The investment needs in the health sector to address climate-sensitive health outcomes are large. Additional human and financial resources will be needed to prevent and control the projected increased burden of health outcomes due to climate change.

  10. Accountability and governance in local public services: The particular case of mixed companies

    Directory of Open Access Journals (Sweden)

    Nuno Ferreira da Cruz

    2011-12-01

    Full Text Available The growing budget restrictions and decentralization processes that local governments face nowadays are threatening the sustainability of local public services. To overcome this problem, local decision-makers around the world have been developing ambiguous reforms, leading to various governance models. Since these services are essential for citizens’ welfare, it is crucial to determine whether or not these models have been effective and useful to cope with this state of affairs. To offer extra leverage to key projects, the European governments have been resorting to public-private partnerships (PPPs. One of the visible trends, which lacks further research, has been the use of mixed public-private companies (institutionalized PPPs. Although it is recognized that this solution can be interesting for both public and private sides, it has some particular features that can avert the aimed goals. This paper provides a literature review on mixed companies encompassing theoretical, legal and operational aspects. It also focuses on regulation by contract, referring to a particular Portuguese case study in the water sector and explaining how the municipality handled risk allocation and regulated the access to the market of private investors. Finally, it discusses the need for external regulation and makes suggestions on how these processes should be managed right from the bidding stage

  11. A Cost Containment Case for Occupational Illness and Injury Case Management

    Science.gov (United States)

    1988-06-15

    retrospective reviews, and negotiated rates; (3) new or marginal clinical entities, such as chiropractic , should be carefully monitored; (4) a single state...Walsh, 1977), diabetes mellitus and hypertension and related arteriosclerotic and hypertensive heart disease (Komaroff, Black, Flatley, Knopp... hypertension . N Engl J Med 1974; 290:307-312. Komaroff AL, Flatley M, Browne C, Sherman H, Fineberg SE, Knopp RH. Quality, efficiency, and cost of a

  12. Three case studies involving Leptospira interrogans serovar pomona infection in mixed farming units.

    Science.gov (United States)

    Gummow, B; Myburgh, J G; Thompson, P N; van der Lugt, J J; Spencer, B T

    1999-03-01

    Three case studies involving Leptospira interrogans serovar pomona outbreaks within mixed farming systems in South Africa are described. On 2 farms, pigs constituted the main enterprise with cattle and sheep of secondary importance. On each of these 2 farms, abortion due to L. pomona in sows was confirmed by culture, and antibody titres to pomona were detected in cattle, sheep, horses and dogs. On the 3rd farm, a piggery was of secondary importance to cattle farming. Abortion and death in cows occurred on this farm and serology showed titres to various serovars, including pomona. L. pomona was also isolated from bovine urine, an aborted bovine foetus and kidneys from slaughtered pigs. This particular case study was regarded as clinically atypical in that adult Jersey cattle died of acute leptospirosis in a semiarid region of South Africa. In all 3 case studies, the poor management of pig effluent and of the drinking water and its sources played a pivotal role in the transmission of the disease. Inadequate vaccination of animals against Leptospira and poor record-keeping within the secondary farming enterprises were also contributing factors to the spread of leptospirosis.

  13. Costs of cloud computing for a biometry department. A case study.

    Science.gov (United States)

    Knaus, J; Hieke, S; Binder, H; Schwarzer, G

    2013-01-01

    "Cloud" computing providers, such as the Amazon Web Services (AWS), offer stable and scalable computational resources based on hardware virtualization, with short, usually hourly, billing periods. The idea of pay-as-you-use seems appealing for biometry research units which have only limited access to university or corporate data center resources or grids. This case study compares the costs of an existing heterogeneous on-site hardware pool in a Medical Biometry and Statistics department to a comparable AWS offer. The "total cost of ownership", including all direct costs, is determined for the on-site hardware, and hourly prices are derived, based on actual system utilization during the year 2011. Indirect costs, which are difficult to quantify are not included in this comparison, but nevertheless some rough guidance from our experience is given. To indicate the scale of costs for a methodological research project, a simulation study of a permutation-based statistical approach is performed using AWS and on-site hardware. In the presented case, with a system utilization of 25-30 percent and 3-5-year amortization, on-site hardware can result in smaller costs, compared to hourly rental in the cloud dependent on the instance chosen. Renting cloud instances with sufficient main memory is a deciding factor in this comparison. Costs for on-site hardware may vary, depending on the specific infrastructure at a research unit, but have only moderate impact on the overall comparison and subsequent decision for obtaining affordable scientific computing resources. Overall utilization has a much stronger impact as it determines the actual computing hours needed per year. Taking this into ac count, cloud computing might still be a viable option for projects with limited maturity, or as a supplement for short peaks in demand.

  14. Behavioral and neuronal changes during treatment of mixed transcortical aphasia: a case study.

    Science.gov (United States)

    Pulvermüller, F; Schönle, P W

    1993-08-01

    The development of language mechanisms outside the traditional language regions is evidenced by the case of K.S., a patient with chronic mixed transcortical aphasia, that is, good repetition performance compared to all other language abilities. The aphasia was caused by an infarction of the left a. carotis interna that completely destroyed the left perisylvian language region and adjacent structures. Five years post onset the patient underwent intensive aphasia therapy. In the treatment setting chosen, both speech production and comprehension abilities improved as demonstrated by adequacy and reaction time scores. It is argued that the behavioral changes observed are likely to be due to (a) newly acquired communicative strategies and (b) neuronal changes within K.S.'s brain. The behavioral changes are explained in terms of strengthening of synaptic connections and formation of Hebbian cell assemblies corresponding to words.

  15. Mixed total anomalous pulmonary venous connection: Case report with bilateral venous collectors.

    Science.gov (United States)

    Cayre, Raul O; Civetta, Julio D; Roldan, Alberto O; Rousseau, Juan J; Knudson, Ole A; Valdes-Cruz, Lilliam M

    2003-01-01

    We present a case report of a 3-month-old boy with a mixed total anomalous pulmonary venous connection. The patient had situs solitus, small atrial septal defect, and 2 separate venous collectors. The right pulmonary veins drained through a right-sided venous collector into the coronary sinus. The left-sided pulmonary veins drained through the left-sided venous collector directly into the right superior vena cava. The use of the echocardiogram and Doppler color flow mapping to establish a detailed morphologic analysis, the sites of connection, and the presence of pulmonary venous obstructions as well as the value of this information to facilitate a successful surgical repair are discussed.

  16. The "extended" endoscopic endonasal approach for the removal of a mixed intrasuprasellar germinoma: Technical case report

    Directory of Open Access Journals (Sweden)

    Alberto Di Somma

    2014-01-01

    Full Text Available Background: Intracranial germ cell tumors (GCTs represent less than 5% of pediatric brain tumors. Neurosurgical treatment remains essential in the management of patients with intracranial nongerminomatous GCT. Case Description: A 12-year-old girl presented with clinical features of neurohypophyseal dysfunction and rapidly progressive visual worsening. Magnetic resonance imaging (MRI showed a lesion arising from the sella with a significant suprasellar component, compressing the optic chiasm and extending into the third ventricle. The tumor was removed via an endoscopic endonasal transtuberculum-transplanum approach and the histology revealed a mixed germinoma. In the postoperative course, a conspicuous improvement of visual function was observed; an early postoperative MRI showed near-total removal of the lesion. The patient was referred to pediatric oncologist for the adjunctive chemotherapy and radiotherapy. Conclusions: The management of primary intracranial sellar and suprasellar germinomas still remains controversial. With this report we highlighted another possible surgical option among therapeutic strategies for these highly malignant tumors.

  17. A case of gastric mixed adenoneuroendocrine carcinoma with difficulty in diagnosis before endoscopic submucosal dissection.

    Science.gov (United States)

    Sakatani, Akihiko; Shinzaki, Shinichiro; Hayashi, Yoshito; Maekawa, Akira; Hiyama, Satoshi; Yakushijin, Takayuki; Tatsumi, Tomohide; Iijima, Hideki; Hiramatsu, Naoki; Morii, Eiichi; Takehara, Tetsuo

    A woman in her 60s was referred to our hospital with a superficial depressed lesion measuring 8mm in diameter on the lesser curvature of the lower gastric body. Initial biopsy of the lesion indicated a moderately differentiated adenocarcinoma. Endoscopic submucosal dissection was performed, and pathological examination revealed a tumor comprised of adenocarcinoma and neuroendocrine carcinoma with submucosal infiltration, with the final pathological diagnosis being gastric mixed adenoneuroendocrine carcinoma (MANEC). Laparoscopic gastrectomy was subsequently performed. No recurrence was observed after 18 months. Most neuroendocrine carcinomas including MANEC are diagnosed at an advanced stage and require surgical resection. Here we report a case of gastric MANEC mimicking early gastric cancer that was removed en bloc via endoscopic submucosal dissection.

  18. Scleroderma renal crisis in a case of mixed connective tissue disease

    Directory of Open Access Journals (Sweden)

    Mukul Vij

    2014-01-01

    Full Text Available Mixed connective tissue disease (MCTD is an overlap syndrome first defined in 1972 by Sharp et al. In this original study, the portrait emerged of a connective tissue disorder sharing features of systemic lupus erythematosus, systemic sclerosis (scleroderma and polymyositis. Scleroderma renal crisis (SRC is an extremely infrequent but serious complication that can occur in MCTD. The histologic picture of SRC is that of a thrombotic micro-angiopathic process. Renal biopsy plays an important role in confirming the clinical diagnosis, excluding overlapping/superimposed diseases that might lead to acute renal failure in MCTD patients, helping to predict the clinical outcome and optimizing patient management. We herewith report a rare case of SRC in a patient with MCTD and review the relevant literature.

  19. Traumatic anterior shoulder dislocation: a case study of nonoperative management in a mixed martial arts athlete.

    Science.gov (United States)

    Sims, Kevin; Spina, Andreo

    2009-12-01

    To present an evidence-informed approach to the nonoperative management of a first-time, traumatic anterior shoulder dislocation. A 30-year-old mixed martial arts athlete, with no prior shoulder injuries, presented one day following a first-time, traumatic anterior shoulder dislocation. An eight-week, individualized, intensive, nonoperative rehabilitation program was immediately begun upon presentation. Management consisted of immobilization of the shoulder in external rotation and a progressive rehabilitation program aimed at restoring range of motion, strength of the dynamic stabilizers, and proprioception of the shoulder. Eight weeks post-dislocation the patient had regained full range of motion and strength compared to the unaffected limb and apprehension and relocation tests for instability were negative. This case illustrates successful management of a first-time, traumatic, anterior shoulder dislocation using immobilization in external rotation combined with an intensive rehabilitation program.

  20. Case Study to Apply Work Difficulty Factors to Decommissioning Cost Estimates

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Taesik; Jung, Hyejin; Oh, Jaeyoung; Kim, Younggook [KHNP CRI, Daejeon (Korea, Republic of)

    2016-10-15

    This article is prepared as a guideline regarding how to apply the work difficult factor (WDF) when it comes to the estimates of the decommissioning costs. Although several cases of the decommissioning cost estimates have been made for a few commercial nuclear power plants, the different technical, site-specific economic assumptions used make it difficult to interpret those cost estimates and compare them with that of Kori-1. In addition, it is clear that we are supposed to experience difficulties being created in the process of the Kori-1 and the virtual inaccessibility to the limited areas at the pre-decommissioning stage. Estimating decommissioning costs is one of the most crucial processes since it encompasses all the spectrum of decommissioning activities from the planning to the last evaluation on whether the decommissioning has successfully been proceeded from the safety and economic perspectives. Here I suggested the activity dependent costs is only related to WDFs of the incumbent plant planning or undergone to be decommissioned since as a matter of fact, estimating WDFs is the core process to articulately scrutinize the practical costs to apply to Kori-1 project.

  1. Cost-effectiveness of introducing a rotavirus vaccine in developing countries: The case of Mexico

    Directory of Open Access Journals (Sweden)

    Gutierrez Juan-Pablo

    2008-07-01

    Full Text Available Abstract Background In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. Methods A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. Results Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%, 5,040 hospital admissions (66%, and 612 deaths from rotavirus gastroenteritis (70%. At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. Conclusion At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine

  2. Cost-effectiveness of introducing a rotavirus vaccine in developing countries: the case of Mexico.

    Science.gov (United States)

    Valencia-Mendoza, Atanacio; Bertozzi, Stefano M; Gutierrez, Juan-Pablo; Itzler, Robbin

    2008-07-29

    In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%), 5,040 hospital admissions (66%), and 612 deaths from rotavirus gastroenteritis (70%). At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine is likely to be significantly more cost-effective among poorer

  3. Cost-effectiveness of introducing a rotavirus vaccine in developing countries: The case of Mexico

    Science.gov (United States)

    Valencia-Mendoza, Atanacio; Bertozzi, Stefano M; Gutierrez, Juan-Pablo; Itzler, Robbin

    2008-01-01

    Background In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. Methods A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. Results Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%), 5,040 hospital admissions (66%), and 612 deaths from rotavirus gastroenteritis (70%). At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. Conclusion At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine is likely to be

  4. Comparison of the Theory of Constraints with the Traditional Cost Accounting Methods in Respect to Product Mix Decisions Comparison of the Theory of Constraints with the Traditional Cost Accounting Methods in Respect to Product Mix Decisions = Ürün Karması Kararları Açısından Geleneksel Maliyet Muhasebesi Yöntemleri ile Kısıtlar Teorisinin Karşılaştırılması

    Directory of Open Access Journals (Sweden)

    Ayten ERSOY

    2011-08-01

    Full Text Available This study examines the importance of the theory of constraints compared to the conventional cost accounting in making adequate product mix decisions. To this end, an application in a chemistry enterprise was executed to determine product mix decisions and their effect on profitability by comparing the theory of constraints variable costing method with the full costing method in respect to the throughput approach, the contribution margin approach and the unit profit approach respectively.

  5. How to Get Cost-Effectiveness Analysis Right? The Case of Vaccine Economics in Latin America.

    Science.gov (United States)

    Glassman, Amanda; Cañón, Oscar; Silverman, Rachel

    2016-12-01

    In middle-income countries, vaccines against pneumococcal disease, rotavirus, and human papilloma virus are in general more costly, not necessarily cost saving, and less consistently cost-effective than earlier generation vaccines against measles, diphtheria, tetanus, and pertussis. Budget impact is also substantial; public spending on vaccines in countries adopting new vaccines is, on average, double the amount of countries that have not adopted. Policymakers must weigh the costs and benefits of the adoption decision carefully, given the low coverage of other kinds of cost-effective health and nonhealth interventions in these same settings and relatively flat overall public spending on health as a share of gross domestic product (GDP) over time. This paper considers lessons learned from recent vaccine cost-effectiveness analyses and subsequent adoption decisions in Latin America a, largely under the auspices of the Pro Vac Initiative. The paper illustrates how small methodological choices and seemingly minor technical limitations of cost-effectiveness models can have major implications for the studies' conclusions, potentially influencing countries' subsequent vaccine adoption decisions. We evaluate the ProVac models and technical outputs against the standards and framework set out by the International Decision Support Initiative Reference Case for economic evaluation and consider the practical effects of deviations from those standards. Lessons learned are discussed, including issues of appropriate comparators, GDP-based thresholds, and use of average versus incremental cost-effectiveness ratios as a convention are assessed. The article ends with recommendations for the future. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. Costs of work-related musculoskeletal disorders (MSDs) in developing countries: Colombia case.

    Science.gov (United States)

    Piedrahita, Hugo

    2006-01-01

    The real burden of occupational diseases, specifically work-related musculoskeletal disorders (MSDs), and its impact on workers' productivity is not known. The situation is critical in developing countries where only cases that cause workers' disability are recorded. In this study, the incidence of MSDs in Colombia was estimated by using the age and gender specific double incidence rate of repetitive strain injuries diseases in Finland for 2002. The results showed that the estimated number of MSDs recorded in Colombia during 2005 was 23,477 cases at the rate of 11.6 cases per 10,000 workers. The estimated total cost of these MSD cases relative to workers' productivity was 171.7 million US Dollars, representing around 0.2% of Colombia's Gross Domestic Product for 2005. The systematic appraisal of the incidence of MSDs and their associated cost on workers' productivity are necessary in developing countries to reduce the costly impact on productivity and to increase workers' well-being.

  7. Social Cost of Leptospirosis Cases Attributed to the 2011 Disaster Striking Nova Friburgo, Brazil

    Directory of Open Access Journals (Sweden)

    Carlos Pereira

    2014-04-01

    Full Text Available The aim of this study was to estimate the social cost of the leptospirosis cases that were attributed to the natural disaster of January 2011 in Nova Friburgo (State of Rio de Janeiro, Brazil through a partial economic assessment. This study utilized secondary data supplied by the Municipal Health Foundation of Nova Friburgo. Income scenarios based on the national and state minimum wages and on average income of the local population were employed. The total social cost of leptospirosis cases attributed to the 2011 disaster may range between US$21,500 and US$66,000 for the lower income scenario and between US$23,900 and US$100,800 for that of higher income. Empirical therapy represented a total avoided cost of US$14,800, in addition to a reduction in lethality. An estimated 31 deaths were avoided among confirmed cases of the disease, and no deaths resulted from the leptospirosis cases attributed to the natural disaster. There has been a significant post-disaster rise in leptospirosis incidence in the municipality, which illustrates the potential for increased cases—and hence costs—of this illness following natural disasters, which justifies the adoption of preventive measures in environmental health.

  8. Step-by-step Guideline for disease-specific costing studies in low and middle income countries: a mixed methodology.

    NARCIS (Netherlands)

    M.E. Hendriks (Marleen); P. Kundu; A.C. Boers (Alexander); O.A. Bolarinwa (Oladimeji Akeem); M.J. te Pas (Mark); T.M. Akande (Tanimola); K. Agbede (Kayode); G.B. Gomez; W.K. Redekop (Ken); C. Schultsz (Constance); S.S. Tan (Siok Swan)

    2014-01-01

    markdownabstract__Abstract__ BACKGROUND: Disease-specific costing studies can be used as input into cost-effectiveness analyses and provide important information for efficient resource allocation. However, limited data availability and limited expertise constrain such studies in low- and middle-inc

  9. Applying cost analyses to drive policy that protects children. Mercury as a case study

    Energy Technology Data Exchange (ETDEWEB)

    Leonardo Trasande; Clyde Schechter; Karla A. Haynes; Philip J. Landrigan [Mount Sinai School of Medicine, New York, NY (United States). Department of Community and Preventive Medicine

    2006-09-15

    Exposure in prenatal life to methylmercury (MeHg) has become the topic of intense debate in the United States after the Environmental Protection Agency (EPA) announced a proposal in 2004 to reverse strict controls on emissions of mercury from coal-fired power plants that had been in effect for the preceding 15 years. This proposal failed to incorporate any consideration of the health impacts on children that would result from increased mercury emissions. We assessed the impact on children's health of industrial mercury emissions and found that between 316,588 and 637,233 babies are born with mercury-related losses of cognitive function ranging from 0.2 to 5.13 points. We calculated that decreased economic productivity resulting from diminished intelligence over a lifetime results in an aggregate economic cost in each annual birth cohort of $8.7 billion annually. $1.3 billion of this cost is attributable to mercury emitted from American coal-fired power plants. Downward shifts in intellectual quotient (IQ) are also associated with 1566 excess cases of mental retardation annually. This number accounts for 3.2% of MR cases in the United States. If the lifetime excess cost of a case of MR is $1,248,648 in 2000 dollars, then the cost of these excess cases of MR is $2.0 billion annually. Preliminary data suggest that more stringent mercury policy options would prevent thousands of cases of MR and billions of dollars over the next 25 years.

  10. Time-Driven Activity-Based Costing for Inter-Library Services: A Case Study in a University

    Science.gov (United States)

    Pernot, Eli; Roodhooft, Filip; Van den Abbeele, Alexandra

    2007-01-01

    Although the true costs of inter-library loans (ILL) are unknown, universities increasingly rely on them to provide better library services at lower costs. Through a case study, we show how to perform a time-driven activity-based costing analysis of ILL and provide evidence of the benefits of such an analysis.

  11. 75 FR 13414 - Federal Acquisition Regulation; FAR Case 2008-012, Clarification of Submission of Cost or Pricing...

    Science.gov (United States)

    2010-03-19

    ... Regulation; FAR Case 2008-012, Clarification of Submission of Cost or Pricing Data on Non-Commercial... 814 required the harmonization of the thresholds for cost or pricing data. Specifically, section 814 required alignment of the threshold for cost or pricing data on non-commercial modifications of...

  12. 73 Activity Based Costing and Product Pricing Decision: the Nigerian Case

    National Research Council Canada - National Science Library

    Ebipanipre Gabriel Mieseigha

    2014-01-01

    .... The implication is that traditional costing approach fails in many pricing situations by arbitrarily allocating indirect cost and activity based costing helps in allocating indirect cost accurately...

  13. Costs and benefits of pneumatic collection in three specific New York City cases.

    Science.gov (United States)

    Miller, Benjamin; Spertus, Juliette; Kamga, Camille

    2014-11-01

    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 have 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

  14. Why carers use adult day respite: a mixed method case study.

    Science.gov (United States)

    Stirling, Christine M; Dwan, Corinna A; McKenzie, Angela R

    2014-06-06

    We need to improve our understanding of the complex interactions between family carers' emotional relationships with care-recipients and carers use of support services. This study assessed carer's expectations and perceptions of adult day respite services and their commitment to using services. A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation's day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow's hierarchy of needs during analysis. Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow's hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers' use of day respite services.

  15. Thrombotic Thrombocytopenic Purpura Associated with Mixed Connective Tissue Disease: A Case Report

    Directory of Open Access Journals (Sweden)

    João Tadeu Damian Souto Filho

    2011-01-01

    Full Text Available Thrombotic thrombocytopenic purpura (TTP is a multisystemic disorder characterized by microangiopathic hemolytic anemia and thrombocytopenia, which may be accompanied by fever, renal, or neurologic abnormalities. Cases are divided into acute idiopathic TTP and secondary TTP. Autoimmune diseases, especially systemic lupus erythematosus, in association with TTP have been described so far in many patients. In contrast, TTP occurring in a patient with mixed connected tissue disease (MCTD is extremely rare and has only been described in nine patients. We describe the case of a 42-year-old female with MCTD who developed thrombocytopenia, microangiopathic hemolytic anemia, fever, and neurological symptoms. The patient had a good clinical evolution with infusion of high volume of fresh frozen plasma, steroid therapy, and support in an intensive care unit. Although the occurrence of TTP is rare in MCTD patients, it is important to recognize TTP as a cause of thrombocytopenia and hemolytic anemia in any patient with autoimmune diseases. Prompt institution of treatment remains the cornerstone of treatment of TTP even if plasma exchange is not available like what frequently happens in developing countries.

  16. Some regional costs of a synthetic fuel industry: The case of illinois

    Science.gov (United States)

    Attanasi, E.D.; Green, E.K.

    1981-01-01

    The Federal Government's efforts to induce development of a coal-based synthetic fuel industry include direct subsidies, tax concessions, and assurances that it will purchase the industry's output, even if above the market price. In this note it is argued that these subsidies will enable this industry to secure a region's largest and lowest-cost coal deposits and that the costs imposed on other coal users will be substantial. Moreover, because the lowest-cost coal deposits will be committed to synthetic fuels production regardless of the industry's commercial viability, distortions in regional coal markets will develop. If economic efficiency requires that the price of the resource reflect its replacement value, then a State government is justified in imposing a tax on coal destined for subsidized synthetic fuel plants. Amounts of such a tax, based on the higher costs of coal that must be accepted by other users as the result of the subsidized synthetic fuel plants' preempting the largest and lowest-cost deposits, are estimated for the case of Illinois strippable coal. ?? 1981 Annals of Regional Science.

  17. Estimating the Proportion of Childhood Cancer Cases and Costs Attributable to the Environment in California.

    Science.gov (United States)

    Nelson, Lauren; Valle, Jhaqueline; King, Galatea; Mills, Paul K; Richardson, Maxwell J; Roberts, Eric M; Smith, Daniel; English, Paul

    2017-05-01

    To estimate the proportion of cases and costs of the most common cancers among children aged 0 to 14 years (leukemia, lymphoma, and brain or central nervous system tumors) that were attributable to preventable environmental pollution in California in 2013. We conducted a literature review to identify preventable environmental hazards associated with childhood cancer. We combined risk estimates with California-specific exposure prevalence estimates to calculate hazard-specific environmental attributable fractions (EAFs). We combined hazard-specific EAFs to estimate EAFs for each cancer and calculated an overall EAF. Estimated economic costs included annual (indirect and direct medical) and lifetime costs. Hazards associated with childhood cancer risks included tobacco smoke, residential exposures, and parental occupational exposures. Estimated EAFs for leukemia, lymphoma, and brain or central nervous system cancer were 21.3% (range = 11.7%-30.9%), 16.1% (range = 15.0%-17.2%), and 2.0% (range = 1.7%-2.2%), respectively. The combined EAF was 15.1% (range = 9.4%-20.7%), representing $18.6 million (range = $11.6 to $25.5 million) in annual costs and $31 million in lifetime costs. Reducing environmental hazards and exposures in California could substantially reduce the human burden of childhood cancer and result in significant annual and lifetime savings.

  18. Indirect costs of diabetes and its impact on the public finance: the case of Poland.

    Science.gov (United States)

    Torój, Andrzej; Mela, Aneta

    2017-08-31

    Growing public and private expenditure on healthcare results i.a. from the spreading of chronic diseases. Diabetes belongs to the most frequent ones, beyond neoplasms and cardiological diseases, and hence generates a significant burden for the public finance in terms of the direct costs. However, the economy suffers also from the indirect cost of diabetes that manifests itself in the loss in Gross Domestic Product (GDP) and general government revenues. This paper aims to measure this indirect cost, both in terms of GDP drop (social perspective) and public revenue drop (public finance perspective), in the case of Poland in 2012-2014. We use a modified human capital approach and unique dataset provided by the Social Security institution in Poland and the Polish Central Statistical Office. Diabetes is a substantial and growing burden for the Polish economy. In the years 2012, 2013 and 2014 the indirect cost (output loss) amounted to 1.85 bn USD, 1.94 bn USD and 2.00 bn USD respectively. Estimated indirect cost of diabetes can be a useful input for health technology analyses of drugs or economic impact assessments of public health programmes.

  19. Traditional Commerce Versus Electronic Commerce: A Case Study Under The Logistics Costs Management View

    Directory of Open Access Journals (Sweden)

    Marcos Antônio de Souza

    2014-08-01

    Full Text Available The aim of this article is to see how a large Brazilian company of the retail sector makes the measurement and analysis of logistics costs of both its physical operations (traditional trade as their virtual transactions (e-commerce. The research has been conducted in the contributions of strategic cost management for business sustainability. This is an unique descriptive case study, with a qualitative approach, performed in the 2nd half of 2013. Data were collected through interviews, document analysis and in situ observations. Data analyzes occurred by comparative interpretations. The main results showed no significant differences in the analysis and measurement of logistics costs between the two forms of trading. This can be explained partly by the fact that the company does not deal with electronic commerce differently in relation to the management of logistics costs. That is, both the operations of the virtual store as physical stores share the same logistics structure. Additional logistics costs in e-commerce are offset by higher margin practiced in this business model.

  20. Parkinson Symptoms and Health Related Quality of Life as Predictors of Costs: A Longitudinal Observational Study with Linear Mixed Model Analysis.

    Directory of Open Access Journals (Sweden)

    Pablo Martinez-Martín

    Full Text Available To estimate the magnitude in which Parkinson's disease (PD symptoms and health- related quality of life (HRQoL determined PD costs over a 4-year period.Data collected during 3-month, each year, for 4 years, from the ELEP study, included sociodemographic, clinical and use of resources information. Costs were calculated yearly, as mean 3-month costs/patient and updated to Spanish €, 2012. Mixed linear models were performed to analyze total, direct and indirect costs based on symptoms and HRQoL.One-hundred and seventy four patients were included. Mean (SD age: 63 (11 years, mean (SD disease duration: 8 (6 years. Ninety-three percent were HY I, II or III (mild or moderate disease. Forty-nine percent remained in the same stage during the study period. Clinical evaluation and HRQoL scales showed relatively slight changes over time, demonstrating a stable group overall. Mean (SD PD total costs augmented 92.5%, from € 2,082.17 (€ 2,889.86 in year 1 to € 4,008.6 (€ 7,757.35 in year 4. Total, direct and indirect cost incremented 45.96%, 35.63%, and 69.69% for mild disease, respectively, whereas increased 166.52% for total, 55.68% for direct and 347.85% for indirect cost in patients with moderate PD. For severe patients, cost remained almost the same throughout the study. For each additional point in the SCOPA-Motor scale total costs increased € 75.72 (p = 0.0174; for each additional point on SCOPA-Motor and the SCOPA-COG, direct costs incremented € 49.21 (p = 0.0094 and € 44.81 (p = 0.0404, respectively; and for each extra point on the pain scale, indirect costs increased € 16.31 (p = 0.0228.PD is an expensive disease in Spain. Disease progression and severity as well as motor and cognitive dysfunctions are major drivers of costs increments. Therapeutic measures aimed at controlling progression and symptoms could help contain disease expenses.

  1. Mixed Methods in Emerging Academic Subdisciplines : The Case of Sport Management

    NARCIS (Netherlands)

    van der Roest, Jan Willem; Spaaij, Ramón; van Bottenburg, Maarten

    2015-01-01

    This article examines the prevalence and characteristics of mixed methods research in the relatively new subdiscipline of sport management. A mixed methods study is undertaken to evaluate the epistemological/philosophical, methodological, and technical levels of mixed methods design in sport managem

  2. Mixed methods in emerging academic subdisciplines: the case of sport management

    NARCIS (Netherlands)

    van der Roest, J.-W.; Spaaij, R.; van Bottenburg, M.

    2015-01-01

    This article examines the prevalence and characteristics of mixed methods research in the relatively new subdiscipline of sport management. A mixed methods study is undertaken to evaluate the epistemological/philosophical, methodological, and technical levels of mixed methods design in sport managem

  3. Mixed Methods in Emerging Academic Subdisciplines : The Case of Sport Management

    NARCIS (Netherlands)

    van der Roest, Jan Willem; Spaaij, Ramón; van Bottenburg, Maarten

    2015-01-01

    This article examines the prevalence and characteristics of mixed methods research in the relatively new subdiscipline of sport management. A mixed methods study is undertaken to evaluate the epistemological/philosophical, methodological, and technical levels of mixed methods design in sport

  4. Mixed methods in emerging academic subdisciplines: the case of sport management

    NARCIS (Netherlands)

    van der Roest, J.-W.; Spaaij, R.; van Bottenburg, M.

    2015-01-01

    This article examines the prevalence and characteristics of mixed methods research in the relatively new subdiscipline of sport management. A mixed methods study is undertaken to evaluate the epistemological/philosophical, methodological, and technical levels of mixed methods design in sport

  5. Mixed Methods in Emerging Academic Subdisciplines: The Case of Sport Management

    Science.gov (United States)

    van der Roest, Jan-Willem; Spaaij, Ramón; van Bottenburg, Maarten

    2015-01-01

    This article examines the prevalence and characteristics of mixed methods research in the relatively new subdiscipline of sport management. A mixed methods study is undertaken to evaluate the epistemological/philosophical, methodological, and technical levels of mixed methods design in sport management research. The results indicate that mixed…

  6. Primary malignant mixed müllerian tumor of the peritoneum a case report with review of the literature

    DEFF Research Database (Denmark)

    Kurshumliu, Fisnik; Rung-Hansen, Helle; Skovlund, Vibeke Ravn

    2011-01-01

    Malignant mixed Müllerian tumor is a rare malignancy of the genital tract and extremely uncommon in extragenital sites. This report describes a case of malignant mixed Müllerian tumor arising in the lower peritoneum of a 72-year-old female patient. The patient presented with ascites, lower...... and the immunohistochemical analysis of our case, we believe that this is a monoclonal tumor with carcinoma being the "precursor" element. Nevertheless, further molecular and genetic evidence is needed to support such a conclusion....

  7. Sustainability cost accounting - Part 2: a case study in the South African process industry

    CSIR Research Space (South Africa)

    Brent, AC

    2007-05-01

    Full Text Available May 2007 Vol 18(1): 1-17 SUSTAINABILITY COST ACCOUNTING - PART 2: A CASE STUDY IN THE SOUTH AFRICAN PROCESS INDUSTRY A.C. Brent1,2, R.P.G. van Erck1 and C. Labuschagne1 1Chair of Life Cycle Engineering Department of Engineering and Technology... Framework, Directorate-General XII, Brussels. [6] Department of Minerals and Energy (DME). 2003. Data retrieved from http://www.dme.gov.za on 26 July 2003. [7] Van Erck, R.P.G. 2003. Monetary evaluation of business sustainability. Case study: GTL fuel...

  8. Technology, safety and costs of decommissioning a reference small mixed oxide fuel fabrication plant. Volume 2. Appendices

    Energy Technology Data Exchange (ETDEWEB)

    Jenkins, C. E.; Murphy, E. S.; Schneider, K. J.

    1979-01-01

    Volume 2 contains appendixes on small MOX fuel fabrication facility description, site description, residual radionuclide inventory estimates, decommissioning, financing, radiation dose methodology, general considerations, packaging and shipping of radioactive materials, cost assessment, and safety (JRD)

  9. Validación retrospectiva del Johns-Hopkins ACG Case-Mix System en la población Española Validating the Adjusted Clinical Groups [ACG] Case-mix System in a Spanish population setting: a multicenter study

    Directory of Open Access Journals (Sweden)

    Antoni Sicras-Mainar

    2009-06-01

    Full Text Available Introducción: Validar la aplicación retrospectiva de los Adjusted Clinical Groups (ACG en varios centros de atención primaria y especializada en la población española. Métodos: Estudio restrospectivo-multicéntrico, realizado a partir de los registros de sujetos atendidos en 5 equipos de atención primaria (AP y dos hospitalarios, durante el año 2005. Las principales mediciones fueron dependientes (visitas, episodios, coste en AP y coste total y de casuística/morbilidad con el ACG Case-Mix-System. Cálculo del poder explicativo: cociente de determinación, pPurpose: To validate the Johns Hopkins ACG case-mix system used in various primary and specialized care centers attending a defined population in Spain. Methods: A retrospective, multicenter study was carried out by applying the ACG case-mix system to the clinical records of patients attending five primary care teams and two hospitals over a 1-year period in 2005. The main measurements were dependent variables (visits, episodes, primary care costs, and total costs, and morbidity. The determination coefficient (R²; p<0.05 was used to measure the explained variability. Results: A total of 81,873 patients were included with a mean (standard deviation number of 4.8 (3.5 episodes and 8.0 (8.1 visits/patient/year. The explained variance (R² of ACG classification was 73.1% (75.5% log transformation for episodes, 43.2% (54.0% log transformation for visits, 19.6% (54.8% log transformation for primary care costs, and 22.7% (48.3% log transformation for total costs (p<0.001. Conclusion: The ACG system classified a defined population on the basis of morbidity and individual resource consumption. Moreover, the ACG system was useful to assess the clinical (comorbidity and economical information of each center.

  10. Exophytic benign mixed epithelial stromal tumour of the kidney: case report of a rare tumour entity

    Directory of Open Access Journals (Sweden)

    Küster Jens

    2010-03-01

    Full Text Available Abstract Background Mixed epithelial and stromal tumour (MEST represents a recently described benign composite neoplasm of the kidney, which predominantly affects perimenopausal females. Most tumours are benign, although rare malignant cases have been observed. Case report A 47-year-old postmenopausal female presented to the urologist with flank pain. A CT scan of the abdomen showed a 30-mm-in-diameter uniform mass adjacent to the pelvis of the left kidney. Surgical exploration showed a tumour arising from the lower anterior hilus of the left kidney. The tumour could be excised by preserving the kidney. By intraoperative frozen section the tumour showed characteristic features of MEST with epithelial-covered cysts embedded in an "ovarian-like" stroma. Additional immunohistochemistry investigations showed expression for hormone receptors by the stromal component of the tumour. Discussion MEST typically presents in perimenopausal women as a primarily cystic mass. Commonly, the tumour arises from the renal parenchyma or pelvis. The tumour is composed of an admixture of cystic and sometimes more solid areas. The stromal cells typically demonstrate an ovarian-type stroma showing expression for the estrogen and progesterone receptors. Conclusion MEST represents a distinctive benign tumour entity of the kidney, which affects perimenopausal woman. The tumour should be distinguished from other cystic renal neoplasms. By imaging studies it is difficult to distinguish between a benign or malignant nature of the tumour. Thus, intraoperative frozen section is necessary for conservative surgery, since the overall prognosis is favourable and renal function can be preserved in most cases.

  11. [Implementation and (cost-)effectiveness of case management for people with dementia and their informal caregivers: results of the COMPAS study].

    Science.gov (United States)

    van Mierlo, Lisa D; MacNeil-Vroomen, Janet; Meiland, Franka J M; Joling, Karlijn J; Bosmans, Judith E; Dröes, Rose Marie; Moll van Charante, Eric P; de Rooij, Sophia E J A; van Hout, Hein P J

    2016-12-01

    Different forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form. Evaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation. A mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs). Outcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group. The integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.

  12. Cost-effective cloud computing: a case study using the comparative genomics tool, roundup.

    Science.gov (United States)

    Kudtarkar, Parul; Deluca, Todd F; Fusaro, Vincent A; Tonellato, Peter J; Wall, Dennis P

    2010-12-22

    Comparative genomics resources, such as ortholog detection tools and repositories are rapidly increasing in scale and complexity. Cloud computing is an emerging technological paradigm that enables researchers to dynamically build a dedicated virtual cluster and may represent a valuable alternative for large computational tools in bioinformatics. In the present manuscript, we optimize the computation of a large-scale comparative genomics resource-Roundup-using cloud computing, describe the proper operating principles required to achieve computational efficiency on the cloud, and detail important procedures for improving cost-effectiveness to ensure maximal computation at minimal costs. Utilizing the comparative genomics tool, Roundup, as a case study, we computed orthologs among 902 fully sequenced genomes on Amazon's Elastic Compute Cloud. For managing the ortholog processes, we designed a strategy to deploy the web service, Elastic MapReduce, and maximize the use of the cloud while simultaneously minimizing costs. Specifically, we created a model to estimate cloud runtime based on the size and complexity of the genomes being compared that determines in advance the optimal order of the jobs to be submitted. We computed orthologous relationships for 245,323 genome-to-genome comparisons on Amazon's computing cloud, a computation that required just over 200 hours and cost $8,000 USD, at least 40% less than expected under a strategy in which genome comparisons were submitted to the cloud randomly with respect to runtime. Our cost savings projections were based on a model that not only demonstrates the optimal strategy for deploying RSD to the cloud, but also finds the optimal cluster size to minimize waste and maximize usage. Our cost-reduction model is readily adaptable for other comparative genomics tools and potentially of significant benefit to labs seeking to take advantage of the cloud as an alternative to local computing infrastructure.

  13. Spectrum of malignancy in mixed tumors of salivary gland: A morphological and immunohistochemical review of 23 cases

    Directory of Open Access Journals (Sweden)

    Qureshi Asim

    2009-04-01

    Full Text Available Malignancy arising in mixed tumors of the salivary gland is a distinct entity that can occur sporadically or in association with a background of pleomorphic adenoma. Carcinoma arising with a background of pleomorphic adenoma is well documented. However, there are rare occurrences of aggressive de novo carcinosarcomas of the parotid that have been reported. Various cell lineages such as the epithelial glandular cells and the stromal spindle cells are involved. We report 23 cases of tumors of the salivary gland comprising 18 cases of carcinoma ex pleomorphic adenoma, four cases of carcinosarcoma of the parotid and one case of benign metastasizing pleomorphic adenoma. The occurrence of various malignancies suggests that this phenomenon is not very uncommon and should be looked for when reporting a mixed tumor.

  14. Case-mix adjustment approach to benchmarking prevalence rates of nosocomial infection in hospitals in Cyprus and Greece.

    Science.gov (United States)

    Kritsotakis, Evangelos I; Dimitriadis, Ioannis; Roumbelaki, Maria; Vounou, Emelia; Kontou, Maria; Papakyriakou, Panikos; Koliou-Mazeri, Maria; Varthalitis, Ioannis; Vrouchos, George; Troulakis, George; Gikas, Achilleas

    2008-08-01

    To examine the effect of heterogeneous case mix for a benchmarking analysis and interhospital comparison of the prevalence rates of nosocomial infection. Cross-sectional survey. Eleven hospitals located in Cyprus and in the region of Crete in Greece. The survey included all inpatients in the medical, surgical, pediatric, and gynecology-obstetrics wards, as well as those in intensive care units. Centers for Disease Control and Prevention criteria were used to define nosocomial infection. The information collected for all patients included demographic characteristics, primary admission diagnosis, Karnofsky functional status index, Charlson comorbidity index, McCabe-Jackson severity of illness classification, use of antibiotics, and prior exposures to medical and surgical risk factors. Outcome data were also recorded for all patients. Case mix-adjusted rates were calculated by using a multivariate logistic regression model for nosocomial infection risk and an indirect standardization method.Results. The overall prevalence rate of nosocomial infection was 7.0% (95% confidence interval, 5.9%-8.3%) among 1,832 screened patients. Significant variation in nosocomial infection rates was observed across hospitals (range, 2.2%-9.6%). Logistic regression analysis indicated that the mean predicted risk of nosocomial infection across hospitals ranged from 3.7% to 10.3%, suggesting considerable variation in patient risk. Case mix-adjusted rates ranged from 2.6% to 12.4%, and the relative ranking of hospitals was affected by case-mix adjustment in 8 cases (72.8%). Nosocomial infection was significantly and independently associated with mortality (adjusted odds ratio, 3.6 [95% confidence interval, 2.1-6.1]). The first attempt to rank the risk of nosocomial infection in these regions demonstrated the importance of accounting for heterogeneous case mix before attempting interhospital comparisons.

  15. Improving Decision Making In Cancer Treatment With A Mix Of Cost-Effectiveness Analysis And Ethical Perspective: Usa Example

    Directory of Open Access Journals (Sweden)

    Kadir GÜRSOY

    2013-11-01

    Full Text Available In the world, healthcare costs have been on the rise and getting larger share in the economic pie. Since we have limited resources, allocation of resources becomes more of an issue. Cancer is one of most leading causes of death in the world and each year, money spent on cancer treatment goes up. However, today new cancer drugs and treatment only provide narrow benefit with very high costs. Therefore, only limited number of people enjoys getting the treatment and fewer treatment or drugs are reimbursed. In addition, many countries do not have a standard to decide whether a cancer drug or a treatment will be covered. Considering both economic efficiency (cost-effectiveness analysis and ethical issues together during the decision process is of great importance so as to distribute health resources fairly and maximize health benefits.

  16. Costs and benefits of pneumatic collection in three specific New York City cases

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Benjamin, E-mail: BenjaminMiller@nyc.rr.com [University Transportation Research Center, Region 2, 910 Marshak Hall, The City College of New York, New York, NY 10031 (United States); Spertus, Juliette, E-mail: Juliette.Spertus@gmail.com [19 Clifton Place, Brooklyn, NY 11238 (United States); Kamga, Camille, E-mail: CKamga@UTRC2.org [University Transportation Research Center, Region 2, 910 Marshak Hall, The City College of New York, New York, NY 10031 (United States)

    2014-11-15

    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 have 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

  17. A case study using the United Republic of Tanzania: costing nationwide HPV vaccine delivery using the WHO Cervical Cancer Prevention and Control Costing Tool

    Directory of Open Access Journals (Sweden)

    Hutubessy Raymond

    2012-11-01

    Full Text Available Abstract Background The purpose, methods, data sources and assumptions behind the World Health Organization (WHO Cervical Cancer Prevention and Control Costing (C4P tool that was developed to assist low- and middle-income countries (LMICs with planning and costing their nationwide human papillomavirus (HPV vaccination program are presented. Tanzania is presented as a case study where the WHO C4P tool was used to cost and plan the roll-out of HPV vaccines nationwide as part of the national comprehensive cervical cancer prevention and control strategy. Methods The WHO C4P tool focuses on estimating the incremental costs to the health system of vaccinating adolescent girls through school-, health facility- and/or outreach-based strategies. No costs to the user (school girls, parents or caregivers are included. Both financial (or costs to the Ministry of Health and economic costs are estimated. The cost components for service delivery include training, vaccination (health personnel time and transport, stationery for tally sheets and vaccination cards, and so on, social mobilization/IEC (information, education and communication, supervision, and monitoring and evaluation (M&E. The costs of all the resources used for HPV vaccination are totaled and shown with and without the estimated cost of the vaccine. The total cost is also divided by the number of doses administered and number of fully immunized girls (FIGs to estimate the cost per dose and cost per FIG. Results Over five years (2011 to 2015, the cost of establishing an HPV vaccine program that delivers three doses of vaccine to girls at schools via phased national introduction (three regions in year 1, ten regions in year 2 and all 26 regions in years 3 to 5 in Tanzania is estimated to be US$9.2 million (excluding vaccine costs and US$31.5 million (with vaccine assuming a vaccine price of US$5 (GAVI 2011, formerly the Global Alliance for Vaccines and Immunizations. This is equivalent to a

  18. Mixed Mucinous and Infiltrating Carcinoma Occurring in Male Breast- Study of Clinico-Pathological Features: A Rare Case Report.

    Science.gov (United States)

    Gupta, Kavita; Sharma, Swati; Kudva, Ranjini; Kumar, Sandeep

    2015-06-01

    Mucinous carcinoma is a less common histologic variant of breast cancer. Cases of mucinous carcinomas in male breast are extremely rare. Here, we describe a case of mixed mucinous carcinoma i.e. mucinous carcinoma with infiltrating ductal carcinoma component and showing apocrine differentiation in a 73-year-old man. This uncommon tumour entity has dismal prognosis and treatment depends largely on the tumour type, size, lymph node involvement and hormonal status.

  19. The Art of Empathy: A Mixed Methods Case Study of a Critical Place-Based Art Education Program

    Science.gov (United States)

    Bertling, Joy Gaulden

    2012-01-01

    This mixed methods case study examined middle school students' empathy with the environment within a critical place-based art classroom. The curriculum was informed by the ecological imagination, which calls for a new mode of education: education that embraces the arts as a way to conceive of pro-ecological perspectives, other ways of being…

  20. Thai Perspectives on the Internationalization of Higher Education in Thailand: A Mixed Methods Analysis and Three Mini-Case Studies

    Science.gov (United States)

    McBride, Karen Anne

    2012-01-01

    This study is a sequential mixed methods study that also includes three mini-case studies for the purpose of portraying contemporary Thai views on the internationalization of higher education in Thailand and reflections on its status as an international education hub in the Southeast Asian region. An inductive analysis technique is used whereby…

  1. Mixed cryoglobulinemia-associated Sjögren's syndrome leading to spontaneous rupture of the kidney: a case report

    Directory of Open Access Journals (Sweden)

    Haddiya I

    2016-03-01

    Full Text Available Intissar Haddiya,1 Hakim Hamzaoui,1 Zitouna Alhamany,2 Fatime-zohra Berkchi,1 Hakima Rhou,1 Loubna Benamar,1 Naima Ouzeddoun,1 Rabea Bayahia1 1Department of Nephrology-Dialysis-Renal Transplantation, Ibn Sina University Hospital, Rabat, Morocco; 2Department of Pathology, Rabat Children's Hospital, Ibn Sina University Hospital, Rabat, Morocco Background: Spontaneous rupture of the kidney is uncommon and is mainly caused by renal tumors. Only a few cases are caused by vasculitis. We report here the first case of spontaneous rupture of kidney resulting from mixed cryoglobulinemia. Case presentation: A 44-year-old man presented with sudden onset of fever, acute pulmonary edema, left flank abdominal pain unassociated with trauma, and rapidly progressive renal failure requiring dialysis. Computed tomography of the abdomen revealed a large perirenal hematoma of the left kidney. During conservative surgery, the patient underwent renal biopsy that showed renal vasculitis and membranoproliferative glomerulonephritis with intracapillary microthrombi. Tests were positive for mixed cryoglobulinemia caused by Sjögren's syndrome. The patient was better after immunosuppressive therapy, with the disappearance of clinical symptoms and the recovery of baseline renal function. Conclusion: We report on this case and discuss a possible link between spontaneous rupture of kidney and mixed cryoglobulinemia-associated Sjögren's syndrome. Keywords: mixed cryoglobulinemia, Sjögren's syndrome, spontaneous rupture of kidney, renal hematoma, Wünderlich syndrome

  2. Listening to the patient as a possible route to cost-effective rehabilitation: a case report

    Directory of Open Access Journals (Sweden)

    Grandi Attilia

    2012-01-01

    Full Text Available Abstract Introduction Adolescents with cerebral palsy often do not need a specific rehabilitative treatment; however, when specific needs are expressed, clinicians should listen and try to answer them. Case presentation We present the case of a 17-year-old Italian male patient with hemiplegia who had received standard physiotherapy and, ultimately, after a period of adapted physical activity performed in a group, was under consideration for discharge. However, due to unsatisfactory hand control, he asked for help to reach a personal goal, the ability to drive a motorbike, without surgery. Functional taping showed efficacy, but was neither cost-effective nor practical for the patient and his family; by contrast, a dynamic orthosis associated with training in a real-life environment was instead successful. Conclusion The present case underlines the importance of considering solutions involving the motivation and compliance of the patient in order to improve his activity and participation.

  3. Estimating truck operating costs for domestic trips – case studies from Greece

    Directory of Open Access Journals (Sweden)

    Sdoukopoulos Eleftherios

    2015-11-01

    Full Text Available The transport sector represents a vital component of national economies and has significant impacts on productivity and social welfare. In 2012, the transport sector in Europe was estimated to account for 3.7% of the European Gross Domestic Product (GDP and 5.1% for employment. Road transport proves to be the predominant mode for moving goods within Europe holding a share of approximately 45.8% in 2012 (in ton-kms. In Greece, the share of road freight transport is significantly higher (98% indicating the importance of this sector for the Greek economy. To this end and considering the existing needs of road freight transport operators in Greece, the objective of this research is to establish an analytical and documented basis for estimating the operating cost of a truck on specific urban or national freight transport routes. To achieve this goal, an extended literature review has been conducted resulting in the identification of the main components comprising the total truck operating cost, which were then updated and validated through a series of personal interviews with selected road freight transport professionals. An excel-based application tool was also developed in order to facilitate operating cost estimates for different cases, through selection of the proper values of the relevant parameters. The resulting tool was used to analyse four test cases, which demonstrate the tool’s usability and applicability. Results from this analysis have been also validated by industry experts and they reflect real-world transport scenarios.

  4. Evaluation of the Cost Estimation Models: Case Study of Task Manager Application

    Directory of Open Access Journals (Sweden)

    Mohammed Mugahed Al Qmase

    2013-10-01

    Full Text Available The need to accurately estimate time and cost for effective planning of software projects is becoming crucial driven by the escalating demands of the software market. Several models proposed in the history of Software Engineering discipline to estimate time, costs associated with planning and managing software projects as Line of Code (LOC, Function Point (FP and Constructive Cost Model (COCOMO. This paper focuses upon the COCOMO Model. It is further consisted of its two sub models called COCOMO I and COCOMO II. The primary objective of this research is to use an appropriate case study to evaluate the accuracy of the sub models COCOMO I and II and ascertain the variation of the realistic resource effort, staff and time. The findings to date show that the Application Composition Model of COCOMO II is more accurate in determining time and cost for the successful conclusion of a software project than the other two COCOMO I and II Models for a similar application for example Task Manager.

  5. The cost of cooking a meal. The case of Nyeri County, Kenya

    Science.gov (United States)

    Fuso Nerini, Francesco; Ray, Charlotte; Boulkaid, Youssef

    2017-06-01

    Energy for cooking is considered essential in achieving modern energy access. Despite this, almost three billion people worldwide still use solid fuels to meet their cooking needs. To better support practitioners and policy-makers, this paper presents a new model for comparing cooking solutions and its key output metric: the ‘levelized cost of cooking a meal’ (LCCM). The model is applied to compare several cooking solutions in the case study area of Nyeri County in Kenya. The cooking access targets are connected to the International Workshop Agreement and Global Tracking Framework’s tiers of cooking energy access. Results show how an increased energy access with improved firewood and charcoal cookstoves could reduce both household’s LCCMs and the total costs compared to traditional firewood cooking over the modelling period. On the other hand, switching to cleaner cooking solutions, such as LPG- and electricity, would result in higher costs for the end-user highlighting that this transition is not straightforward. The paper also contextualizes the results into the wider socio-economic context. It finds that a tradeoff is present between minimizing costs for households and meeting household priorities, thus maximizing the potential benefits of clean cooking without dismissing the use of biomass altogether.

  6. Pancreatic Metastasis from Mixed Adenoneuroendocrine Carcinoma of the Uterine Cervix: A Case Report

    Directory of Open Access Journals (Sweden)

    Chihiro Nishimura

    2013-05-01

    Full Text Available Metastatic cancers of the pancreas are rare, accounting for approximately 2-4% of all pancreatic malignancies. Renal cell carcinoma is the most common solid tumor that metastasizes to the pancreas. Here, we present a case of uterine cervical carcinoma metastasizing to the pancreas and review the literature regarding this rare event. A 44-year-old woman with a uterine cervical tumor had undergone radical hysterectomy and had been diagnosed pathologically with stage Ib mixed adenoneuroendocrine carcinoma in 2004. She underwent concurrent radiotherapy and chemotherapy postoperatively. Pulmonary metastases subsequently appeared in 2008 and 2011, and she underwent complete resection of the lung tumors by video-assisted thoracic surgery. Although she was followed up without any treatment and with no other recurrences, positron emission tomography revealed an area of abnormal uptake within the pancreatic body in 2012. Enhanced computed tomography demonstrated a 20-mm lesion in the pancreatic body and upstream pancreatic duct dilatation. Endoscopic ultrasonography-guided fine needle aspiration was performed and pathological examination suggested neuroendocrine carcinoma (NEC. On the basis of these results and the patient's oncological background, lesions in the pancreatic body were diagnosed as secondary metastasis from the cervical carcinoma that had been treated 8 years earlier. No other distant metastases were visualized, and the patient subsequently underwent middle pancreatectomy. Pathological examination showed NEC consistent with pancreatic metastasis from the uterine cervical carcinoma. The patient has survived 7 months since the middle pancreatectomy without any signs of local recurrence or other metastatic lesions.

  7. Policy Mixes to Achieve Absolute Decoupling: A Case Study of Municipal Waste Management

    Directory of Open Access Journals (Sweden)

    Francesca Montevecchi

    2016-05-01

    Full Text Available Studying the effectiveness of environmental policies is of primary importance to address the unsustainable use of resources that threatens the entire society. Thus, the aim of this paper is to investigate on the effectiveness of environmental policy instruments to decouple waste generation and landfilling from economic growth. In order to do so, the paper analyzes the case study of the Slovakian municipality of Palarikovo, which has drastically improved its waste management system between 2000 and 2012, through the utilization of differentiated waste taxes and awareness-raising and education campaigns, as well as targeting increased recycling and municipal composting. We find evidence of absolute decoupling for landfilled waste and waste generation, the latter being more limited in time and magnitude. These policy instruments could therefore play an important role in municipalities that are still lagging behind in waste management. More specifically, this policy mix was effective in moving away from landfilling, initiating recycling systems, and to some extent decreasing waste generation. Yet, a more explicit focus on waste prevention will be needed to address the entirety of the problem effectively.

  8. All patient refined-diagnostic related group and case mix index in acute care palliative medicine.

    Science.gov (United States)

    Lagman, Ruth L; Walsh, Declan; Davis, Mellar P; Young, Brett

    2007-03-01

    The All Patient Refined-Diagnostic Related Group (APR-DRG) is a modification of the traditional DRG that adds four classes of illness severity and four classes of mortality risk. The APR-DRG is a more accurate assessment of the complexity of care. When individuals with advanced illness are admitted to an acute inpatient palliative medicine unit, there may be a perception that they receive less intense acute care. Most of these patients, however, are multisymptomatic, have several comorbidities, and are older. For all patients admitted to the unit, a guide was followed by staff physicians to document clinical information that included the site(s) of malignancy, site(s) of metastases, disease complications, disease-related symptoms, and comorbidities. We then prospectively compared DRGs, APR-DRGs, and case mix index (CMI) from January 1-June 30, 2003, and February 1-July 31,2004, before and after the use of the guide. The overall mean severity of illness (ASOI) increased by 25% (P < 0.05). The mean CMI increased by 12% (P < 0.05). The average length of stay over the same period increased slightly from 8.97 to 9.56 days. Systematic documentation of clinical findings using a specific tool for patients admitted to an acute inpatient palliative medicine unit based on APR-DRG classifications captured a higher severity of illness and may better reflect resource utilization.

  9. Mixed Hepatoblastoma in a Young Male Adult: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Valeria Fiaschetti

    2010-01-01

    Full Text Available Hepatoblastoma (HB is a rare malignant tumour of the liver and usually occurs in the first three years of life. Most of these tumours arise in the embryo; hence it seems to be unusual that hepatoblastoma occurs in adults and is an exceptional cause of primary malignant liver tumour in adult patients. The diagnosis is often overlooked, and patients might be diagnosed at late stages of the disease at risk of increased mortality. In this paper we report a case of a 30-year-old man with mixed hepatoblastoma and abdominal pain, hepatomegaly and fever. The patient under went noninvasive diagnostic methods: duplex scanning, Computed Tomography (CT, and Magnetic Resonance imaging (MRI. In our experience, despite the important role of histological sample provided by biopsy in defining the diagnosis, very important was the role of MRI, more than ultrasonography and enhanced CT. The MRI detects tumor features as size, margins, and ratio with neighboring organs in order to get the best surgical approach.

  10. Purists need not apply: the case for pragmatism in mixed methods research.

    Science.gov (United States)

    Florczak, Kristine L

    2014-10-01

    The purpose of this column is to describe several different ways of conducting mixed method research. The paradigms that underpin both qualitative and quantitative research are also considered along with a cursory review of classical pragmatism as it relates conducting mixed methods studies. Finally, the idea of loosely coupled systems as a means to support mixed methods studies is proposed along with several caveats to researchers who desire to use this new way of obtaining knowledge. © The Author(s) 2014.

  11. Reducing the Cost of Model-Based Testing through Test Case Diversity

    Science.gov (United States)

    Hemmati, Hadi; Arcuri, Andrea; Briand, Lionel

    Model-based testing (MBT) suffers from two main problems which in many real world systems make MBT impractical: scalability and automatic oracle generation. When no automated oracle is available, or when testing must be performed on actual hardware or a restricted-access network, for example, only a small set of test cases can be executed and evaluated. However, MBT techniques usually generate large sets of test cases when applied to real systems, regardless of the coverage criteria. Therefore, one needs to select a small enough subset of these test cases that have the highest possible fault revealing power. In this paper, we investigate and compare various techniques for rewarding diversity in the selected test cases as a way to increase the likelihood of fault detection. We use a similarity measure defined on the representation of the test cases and use it in several algorithms that aim at maximizing the diversity of test cases. Using an industrial system with actual faults, we found that rewarding diversity leads to higher fault detection compared to the techniques commonly reported in the literature: coverage-based and random selection. Among the investigated algorithms, diversification using Genetic Algorithms is the most cost-effective technique.

  12. A well-based cost function and the economics of exhaustible resources: The case of natural gas

    Energy Technology Data Exchange (ETDEWEB)

    Chermak, J.M. [Naval Postgraduate School, Monterey, CA (United States); Patrick, R.H. [Rutgers Univ., Newark, NJ (United States)

    1995-03-01

    A cost function for natural gas production is estimated, using a pool of data from 29 wells. Statistically exact tests are performed for parameter stability across locations, formations, wells, and producing firms. Costs are determined to be inversely related to remaining recoverable reserves, and marginal costs of production are decreasing in all cases. Theoretical implications of these cost characteristics on optimal exhaustible resource extraction are analyzed. Although marginal cost is decreasing, production effects on the resource stock imply that an interior production path may be optimal. Conditions under which production optimally occurs at the capacity bound are delineated, and optimal interior production paths are characterized. 21 refs., 2 tabs.

  13. COST OF TAX COMPLIANCE AND RISK MANAGEMENT IN PROJECTS: THE CASE STUDY OF A SMALL ENTERPRISE

    Directory of Open Access Journals (Sweden)

    Mario Manzini Cianfanelli

    2010-06-01

    Full Text Available This study uses a risk management perspective to analyze compliance costs arising from overlapping service tax (ST jurisdictions. We study the case of an engineering company providing services to the Companhia de Saneamento Básico do Estado de São Paulo [São Paulo State Sanitation Company] – SABESP, a public entity. The engineering company was contracted under public law 8.666/93, to provide engineering service in several townships in São Paulo’s metropolitan area. Because the laws governing bidding do not permit later modification in price or provider, subsequent double taxation by one municipality cut into the firm’s margins, and should other local governments follow suit, multiple taxation would render the contract untenable for the provider. Our paper models the impact of conflicting jurisdictions on administrative burden, psychological costs and profit constriction and discusses project management techniques for decision making and management in similar situations.

  14. Research of Logistics Cost Based on Saving Algorithm: A Case of A Certain Logistics Company’s Logistics Cost

    OpenAIRE

    Nie Jing; Zeng Wei Yuan; Jing Hong Lei

    2016-01-01

    In recent years, logistics companies of different sizes has been considerably developed all over the country, with the intensified competitions. To stand out in the competitive market, a logistics company must improve its logistics situation, focus on the function of distribution center, reduce logistics costs for enhancing the impact of supply chain, and rapidly response to customer needs. Thus, how to better design or optimize the existing distribution route for reducing logistics costs bec...

  15. How the policy mix impacts innovation : Findings from company case studies on offshore wind in Germany

    NARCIS (Netherlands)

    Reichardt, Kristin; Rogge, Karoline

    2016-01-01

    Transforming the energy system to one with a greater importance of renewables requires redirecting and accelerating technological change. In this transition, so-called policy mixes play a crucial role. Yet precisely how policy mixes affect technological innovation remains poorly understood. To remed

  16. 49 CFR 1109.4 - Mandatory mediation in rate cases to be considered under the stand-alone cost methodology.

    Science.gov (United States)

    2010-10-01

    ... § 1109.4 Mandatory mediation in rate cases to be considered under the stand-alone cost methodology. (a) A..., the Board will assign a mediator to the case. Within 5 business days of the assignment to mediate, the... 49 Transportation 8 2010-10-01 2010-10-01 false Mandatory mediation in rate cases to be considered...

  17. Guaranteed Cost Control for Exponential Synchronization of Cellular Neural Networks with Mixed Time-Varying Delays via Hybrid Feedback Control

    Directory of Open Access Journals (Sweden)

    T. Botmart

    2013-01-01

    Full Text Available The problem of guaranteed cost control for exponential synchronization of cellular neural networks with interval nondifferentiable and distributed time-varying delays via hybrid feedback control is considered. The interval time-varying delay function is not necessary to be differentiable. Based on the construction of improved Lyapunov-Krasovskii functionals is combined with Leibniz-Newton's formula and the technique of dealing with some integral terms. New delay-dependent sufficient conditions for the exponential synchronization of the error systems with memoryless hybrid feedback control are first established in terms of LMIs without introducing any free-weighting matrices. The optimal guaranteed cost control with linear error hybrid feedback is turned into the solvable problem of a set of LMIs. A numerical example is also given to illustrate the effectiveness of the proposed method.

  18. Cost reduction in the production process using the ABC and Lean tools: Case Study in the refrigeration components industry

    Directory of Open Access Journals (Sweden)

    Levi da Silva Guimarães

    2015-03-01

    Full Text Available This paper focuses on production management with respect to operating costs that relate directly to the value of the product. For this study, three methods were used, ABC - Activity Based Costing, which provides accurate information about the knowledge of the real costs, VSM - Value Stream Mapping and Lean Manufacturing. The method adopted for this research was the case study. The study was conducted at a refrigeration components company in the Industrial Center of Manaus. The analyses and observations initially went through the process of mapping the value stream, measuring the current state of activities (cycle time, setup, etc.. After analysis it was possible to map the cost for each activity and finally calculate the cost of the product before and after the improvements resulting from the lean methodology. The results obtained in this study showed a 20% reduction in product costs resulting from operational improvements. The activity-based cost led to a discovery of the real costs of waste. The steps for this study include process mapping through the value stream, measuring the current state of activities (cycle time, setup, etc., establishing the cost driver for each activity, and finally calculating the cost of the product before and after the application of lean improvements. The paper was conducted through literature and descriptive review, and used a case study method. It describes the model that has been tested in a production line for a refrigeration components company from the Manaus Industrial Center, achieving a 20% reduction in product cost.

  19. Mediastinal mixed germ cell tumor in an infertile male with Klinefelter syndrome:A case report and literature review

    Directory of Open Access Journals (Sweden)

    Dinesh Pradhan

    2015-01-01

    Full Text Available Klinefelter syndrome (KS is a well-documented abnormality of the sex chromosome, with an incidence of 1 in 600 newborn males. It is characterized by a 47, XXY or a mosaic karyotype, hypergonadotrophic hypogonadism, infertility, reduced body hair, gynecomastia, and tall stature. Different neoplasms such as breast, testicular, and lymphoreticular malignancies may occur in 1% to2% of the cases with KS. Herein we describe a case of mediastinal mixed germ cell tumor (GCT in a 40-year-old male with KS. Interestingly, this case also had mitral valve prolapse, and an incidental papillary microcarcinoma of the thyroid gland. In view of the presence of pulmonary nodules, antemortem differential diagnoses considered were mycobacterial infection, lymphoma, thymic carcinoma, and a primary/metastatic neoplasm of the lung. As GCT was not considered, the serum markers of a GCT were not performed. The diagnosis of this rare mediastinal mixed GCT with KS was made at autopsy.

  20. A New Approach for Parameter Estimation of Mixed Weibull Distribution:A Case Study in Spindle

    Institute of Scientific and Technical Information of China (English)

    Dongwei Gu; Zhiqiong Wang; Guixiang Shen; Yingzhi Zhang; Xilu Zhao

    2016-01-01

    In order to improve the accuracy and efficiency of graphical method and maximum likelihood estimation ( MLE) in Mixed Weibull distribution parameters estimation, Graphical-GA combines the advantage of graphical method and genetic algorithm ( GA) is proposed. Firstly, with the analysis of Weibull probability paper (WPP), mixed Weibull is identified to data fitting. Secondly, the observed value of shape and scale parameters are obtained by graphical method with least square, then optimizing the parameters of mixed Weibull with GA. Thirdly, with the comparative analysis on graphical method, piecewise Weibull and two⁃Weibull, it shows graphical⁃GA mixed Weibull is the best. Finally, the spindle MTBF point estimation and interval estimation are got based on mixed Weibull distribution. The results indicate that graphical⁃GA are improved effectively and the evaluation of spindle can provide the basis for design and reliability growth.

  1. Fast-Forward on the Green Road to Open Access: The Case Against Mixing Up Green and Gold

    OpenAIRE

    Harnad, Stevan

    2005-01-01

    This article is a critique of: "The 'Green' and 'Gold' Roads to Open Access: The Case for Mixing and Matching" by Jean-Claude Guedon (in Serials Review 30(4) 2004). Open Access (OA) means: free online access to all peer-reviewed journal articles. Jean-Claude Guedon argues against the efficacy of author self-archiving of peer-reviewed journal articles (the "Green" road to OA). He suggests instead that we should convert to Open Access Publishing (the "Golden" road to OA) by "mixing and matching...

  2. Evaluating the cost effectiveness of environmental projects: Case studies in aerospace and defense

    Science.gov (United States)

    Shunk, James F.

    1995-01-01

    Using the replacement technology of high pressure waterjet decoating systems as an example, a simple methodology is presented for developing a cost effectiveness model. The model uses a four-step process to formulate an economic justification designed for presentation to decision makers as an assessment of the value of the replacement technology over conventional methods. Three case studies from major U.S. and international airlines are used to illustrate the methodology and resulting model. Tax and depreciation impacts are also presented as potential additions to the model.

  3. Assessing the Costs and Benefits of Resilience Investments: Tennessee Valley Authority Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Allen, Melissa R. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Wilbanks, Thomas J. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Preston, Benjamin L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kao, Shih-Chieh [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Bradbury, James [U.S. Department of Energy (DOE), Office of Energy Policy and Systems Analysis (EPSA), Washington, DC (United States)

    2017-01-01

    This report describes a general approach for assessing climate change vulnerabilities of an electricity system and evaluating the costs and benefits of certain investments that would increase system resilience. It uses Tennessee Valley Authority (TVA) as a case study, concentrating on the Cumberland River basin area on the northern side of the TVA region. The study focuses in particular on evaluating risks associated with extreme heat wave and drought conditions that could be expected to affect the region by mid-century. Extreme climate event scenarios were developed using a combination of dynamically downscaled output from the Community Earth System Model and historical heat wave and drought conditions in 1993 and 2007, respectively.

  4. The Activity Based Costing method opportunity to assess and master the aircraft maintenance service cost for Third Party: A Case Study

    Directory of Open Access Journals (Sweden)

    Driss Rchid

    2013-01-01

    Full Text Available This work illustrates how to calculate accurate aircraft maintenance costs using Activity Based Costing (ABC. Comparing to traditional cost calculation, the proposed method is useful for aircrafts maintenance activity integrated to Airline Company and who wants to diversify its revenue by selling some available maintenance slots to third party clients for a competitive price. This paper takes base maintenance check process of a Moroccan airline aircrafts maintenance activity as a case study. The actual method used to calculate aircraft maintenance check cost cant not be applied to third party client pricing system. The ABC method shows substantial benefits if it is successfully implemented. Data collection through interviews and questionnaires are the main sources to this study.

  5. Improving Transportation Services for the University of the Thai Chamber of Commerce: A Case Study on Solving the Mixed-Fleet Vehicle Routing Problem with Split Deliveries

    Science.gov (United States)

    Suthikarnnarunai, N.; Olinick, E.

    2009-01-01

    We present a case study on the application of techniques for solving the Vehicle Routing Problem (VRP) to improve the transportation service provided by the University of The Thai Chamber of Commerce to its staff. The problem is modeled as VRP with time windows, split deliveries, and a mixed fleet. An exact algorithm and a heuristic solution procedure are developed to solve the problem and implemented in the AMPL modeling language and CPLEX Integer Programming solver. Empirical results indicate that the heuristic can find relatively good solutions in a small fraction of the time required by the exact method. We also perform sensitivity analysis and find that a savings in outsourcing cost can be achieved with a small increase in vehicle capacity.

  6. The financial benefits of acute inpatient palliative medicine: an inter-institutional comparative analysis by all patient refined-diagnosis related group and case mix index.

    Science.gov (United States)

    Davis, Mellar P; Walsh, Declan; LeGrand, Susan B; Lagman, Ruth L; Harrison, Betty; Rybicki, Lisa

    2005-01-01

    Financial comparisons of acute care hospital services are possible using the Centers for Medicare & Medicaid Services case mix index (CMI) and All Patient Refined-Diagnosis Related Group (APR-DRG) data. We compared The Cleveland Clinic's Inpatient Palliative Medicine (CCIPM) acute care unit's CMI and APR-DRG data with national and peer institution data. Total mean charges per admission to the CCIPM unit were 7,800 dollars lower than at other peer institutions despite an equivalent severity of illness and longer length of stay and higher mortality in the CCIPM unit. The lower charges were due primarily to lower laboratory and pharmaceutical charges. We conclude that an acute inpatient palliative medicine unit operating within a comprehensive integrated palliative medicine program is cost-effective in providing specialized care for people with advanced disease.

  7. The Role of Inflation and Price Escalation Adjustments in Properly Estimating Program Costs: F-35 Case Study

    Science.gov (United States)

    2016-04-30

    Model Estimates for All F-35 Variants Weight growth in all F-35 variants was a driver of cost growth between MS B paper designs and the current ...reflecting updated weight and commonality are in line with cost growth through the Aircraft Weight Growth row. Not accounted for in this application of the...Estimating Program Costs : F-35 Case Study Stanley Horowitz, Assistant Division Director, Institute for Defense Analyses Bruce Harmon, Research Staff Member

  8. Research of Logistics Cost Based on Saving Algorithm: A Case of A Certain Logistics Company’s Logistics Cost

    Directory of Open Access Journals (Sweden)

    Nie Jing

    2016-01-01

    Full Text Available In recent years, logistics companies of different sizes has been considerably developed all over the country, with the intensified competitions. To stand out in the competitive market, a logistics company must improve its logistics situation, focus on the function of distribution center, reduce logistics costs for enhancing the impact of supply chain, and rapidly response to customer needs. Thus, how to better design or optimize the existing distribution route for reducing logistics costs becomes a difficult problem, and this article will do some researches on it.

  9. Cutting the cost of carbon capture: a case for carbon capture and utilization.

    Science.gov (United States)

    Joos, Lennart; Huck, Johanna M; Van Speybroeck, Veronique; Smit, Berend

    2016-10-20

    A significant part of the cost for carbon capture and storage (CCS) is related to the compression of captured CO2 to its supercritical state, at 150 bar and typically 99% purity. These stringent conditions may however not always be necessary for specific cases of carbon capture and utilization (CCU). In this manuscript, we investigate how much the parasitic energy of an adsorbent-based carbon capture process may be lowered by utilizing CO2 at 1 bar and adapting the final purity requirement for CO2 from 99% to 70% or 50%. We compare different CO2 sources: the flue gases of coal-fired or natural gas-fired power plants and ambient air. We evaluate the carbon capture performance of over 60 nanoporous materials and determine the influence of the initial and final CO2 purity on the parasitic energy of the carbon capture process. Moreover, we demonstrate the underlying principles of the parasitic energy minimization in more detail using the commercially available NaX zeolite. Finally, the calculated utilization cost of CO2 is compared with the reported prices for CO2 and published costs for CCS.

  10. Case studies of energy information systems and related technology: Operational practices, costs, and benefits

    Energy Technology Data Exchange (ETDEWEB)

    Motegi, Naoya; Piette, Mary Ann; Kinney, Satkartar; Dewey, Jim

    2003-09-02

    Energy Information Systems (EIS), which can monitor and analyze building energy consumption and related data throughout the Internet, have been increasing in use over the last decade. Though EIS developers describe the capabilities, costs, and benefits of EIS, many of these descriptions are idealized and often insufficient for potential users to evaluate cost, benefit and operational usefulness. LBNL has conducted a series of case studies of existing EIS and related technology installations. This study explored the following questions: (1) How is the EIS used in day-to-day operation? (2) What are the costs and benefits of an EIS? (3) Where do the energy savings come from? This paper reviews the process of these technologies from installation through energy management practice. The study is based on interviews with operators and energy managers who use EIS. Analysis of energy data trended by EIS and utility bills was also conducted to measure the benefit. This paper explores common uses and findings to identify energy savings attributable to EIS, and discusses non-energy benefits as well. This paper also addresses technologies related to EIS that have been demonstrated and evaluated by LBNL.

  11. Primary malignant mixed müllerian tumor of the peritoneum a case report with review of the literature

    DEFF Research Database (Denmark)

    Kurshumliu, Fisnik; Rung-Hansen, Helle; Skovlund, Vibeke Ravn;

    2011-01-01

    Malignant mixed Müllerian tumor is a rare malignancy of the genital tract and extremely uncommon in extragenital sites. This report describes a case of malignant mixed Müllerian tumor arising in the lower peritoneum of a 72-year-old female patient. The patient presented with ascites, lower...... abdominal mass and pleural effusion. The serum level of CA125 was elevated. At operation a diffuse carcinosis associated with tumor mass measuring 20 × 15 × 10 cm in the vesicouterine and Duglas' pouch were found. The uterus and the adnexa were unremarkable. Histopathology revealed a typical malignant mixed...... Müllerian tumor, heterologous type. The epithelial component was positive for cytokeratin 7 and vimentin whereas the mesenchymal component was positive for Vimentin, S100 and focally for CK7. The histogenesis of this tumor arising from the peritoneum is still speculative. Based on the previous reports...

  12. Case Analysis on Physical Characteristics of Autumn Cumulus-stratus Mixed Cloud in Shandong Province

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    [Objective] The aim was to analyze physical structures of mixed cloud in autumn in Shandong.[Method] By dint of Doppler radar data,the raindrop spectrum data observed by laser spectrometer,second sounding data of L-band,satellite retrieval data,and other general information,the physical structures of mixed cloud in autumn on August 29,2009 were discussed.[Result] This was a typical precipitation process of mixed cloud,and the main precipitation process lasted for 10 hours.Rainfall intensity was ups and down...

  13. Does Mixed Reimbursement Schemes Affect Hospital Activity and Productivity? An Analysis of the Case of Denmark

    DEFF Research Database (Denmark)

    Hansen, Xenia Brun; Bech, Mickael; Jakobsen, Mads Leth

    2013-01-01

    literature with a deeper understanding of such mixed reimbursement systems as well as empirically by identifying key design factors that determines the incentives embedded in such a mixed model. Furthermore, we describe how incentives vary in different designs of the mixed reimbursement scheme and assess...... the period from 2007-2010. A theoretical framework identified the key factors in an ABF/block grant model to be the proportion of the national Diagnosis-Related Group (DRG) tariff above and below a predefined production target (i.e. the baseline); baseline calculations; the presence of kinks...

  14. Public Low-Cost Housing in Malaysia: Case Studies on PPR Low-Cost Flats in Kuala Lumpur

    Directory of Open Access Journals (Sweden)

    Goh, Ai Tee

    2011-06-01

    Full Text Available This paper examines the design quality of People's Housing Project (Program Perumahan Rakyat or PPR low cost high rise flats developed by the National Housing Department (Jabatan Perumahan Negara or JPN in Kuala Lumpur since the 1998. Quality Function Deployment method is used as a tool to analyze the current status and to prioritize the demanded quality from the selected PPR low-cost high rise flats' users. The study revealed that factors in determining a quality low-cost high-rise flat arranged in descending degrees of importance are house safety, provision of public amenities, unit internal environment, maintenance and surrounding environment, location, sanitary fittings, unit size, type of house, material used, unit internal layout, quality of workmanship, structure of the house and appearance. A Quality Chart for PPR low-cost high-rise flats in Kuala Lumpur was presented. Authority (47 per cent has the highest relative degree of importance in determining the quality of PPR flats, followed by Design Element (34 per cent and Quality of Living (19 per cent. Accordingly, the success of the schemes relies strongly on effective control and enforcement by the authorities. However, it can be improved by tackling on the Design Element (Architectural, whereby a revised typical unit layout plan and typical details have been proposed at the last section of the paper.

  15. Cost Determination and Cost Recovery Pricing in Non-Business Situations: The Case of University Research Projects.

    Science.gov (United States)

    Dixon, Keith

    1989-01-01

    A university's income will rise if it changes its policy on charging for commissioned research and for applications to external funding agencies to one of full cost recovery. However, there are a number of technical and policy implications to be appreciated before embarking on the pursuit of additional income. (MSE)

  16. Transaction costs of Tradable White Certificate schemes: The Energy Efficiency Commitment as case study

    Energy Technology Data Exchange (ETDEWEB)

    Mundaca, Luis [International Institute for Industrial Environmental Economics at Lund University, Lund (Sweden)

    2007-08-15

    This paper analyses the nature and scale of transaction costs (TCs) borne by obliged parties under a ''Tradable White Certificate'' (TWC) scheme. Taking the first phase of the Energy Efficiency Commitment (EEC1) in Great Britain as a case study, several sources of TCs were considered, such as search for information, persuasion of customers, negotiation with business partners, and measurement and verification activities. Information was obtained through interviews and a questionnaire distributed to obliged parties. Results show that the most significant sources of TCs were related to search for information, persuading customers and negotiating with managing agents/contractors to implement energy efficiency measures. Perceived high TCs related to contract negotiation and liability risks slightly reduced the low trading level. The scale of TCs was estimated to be around 10% and 30% of total investments costs for the lighting and insulation segments, respectively. The results indicate that, despite the presence and scale of TCs, the EEC1 scheme generated energy savings that yielded net societal benefits. Estimated financial benefits range from 0.6 to 6 p/kWh for insulation and lighting savings, respectively. When avoided external costs due to electricity savings are included, estimated economic benefits range from 3 to 8 p/kWh. Several lessons from the EEC1 can be drawn for TWC schemes. Among others, it is found that informative policy instruments to raise awareness among end-users are critical if a TWC scheme is to deliver cost-effective energy savings. In all, the nature and scale of TCs under TWC schemes will differ because of a number of endogenous and exogenous determinants. (author)

  17. Overlap valence quarks on a twisted mass sea. A case study for mixed action lattice QCD

    Energy Technology Data Exchange (ETDEWEB)

    Cichy, Krzysztof [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany). John von Neumann-Inst. fuer Computing NIC; Poznan Univ. (Poland). Faculty of Physics; Drach, Vincent; Jansen, Karl [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany). John von Neumann-Inst. fuer Computing NIC; Garcia-Ramos, Elena [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany). John von Neumann-Inst. fuer Computing NIC; Humboldt-Universitaet, Berlin (Germany); Herdoiza, Gregorio [UAM/CSIC Univ. Autonoma de Madrid (Spain). Dept. de Fisica Teorica; UAM/CSIC Univ. Autonoma de Madrid (Spain). Inst. de Fisica Teorica; Collaboration: European Twisted Mass Collaboration

    2012-11-15

    We discuss a Lattice QCD mixed action investigation employing Wilson maximally twisted mass sea and overlap valence fermions. Using four values of the lattice spacing, we demonstrate that the overlap Dirac operator assumes a point-like locality in the continuum limit. We also show that by adopting suitable matching conditions for the sea and valence theories a consistent continuum limit for the pion decay constant and light baryon masses can be obtained. Finally, we confront results for sea-valence mixed meson masses and the valence scalar correlator with corresponding expressions of chiral perturbation theory. This allows us to extract low energy constants of mixed action chiral perturbation which characterize the strength of unitarity violations in our mixed action setup.

  18. 1 Malignant mixed Mullerian tumour of the prolapsed cervix: A case ...

    African Journals Online (AJOL)

    Keywords: Malignant mixed Mullerian tumour, cervix, uterine prolapse, Tanzania ... 8x3cm, normal adnexal organs and no para-aortic lymphnodes. Chest x-ray .... where radical vaginal hysterectomy followed by pelvic radiation has been used.

  19. Developing Entrepreneurial Marketing Mix: Case Study of Entrepreneurial Food Enterprises in Iran

    OpenAIRE

    Salamzadeh, Aidin; Rosa MEHRABI; Hamid Khodadad HOSSEINI; Amir Mohammad KOLABI

    2011-01-01

    The purpose of this paper is to identify and exam the main elements of entrepreneurial marketing mix in entrepreneurial enterprises. Our focus in this study is on Iran's top small and medium-size business entrepreneurs in 2007, which possess a brilliant experience about entrepreneurial marketing practices. Accordingly, we aim to identify how these enterprises use their previous knowledge and experience to extract elements of marketing mix, which are adjusted in entrepreneurial marketing. As i...

  20. A Case of the Vibrant Soundbridge Stapes Coupler in Patients with Mixed Hearing Loss

    OpenAIRE

    Park, Ah Young; Jeon, Ju Hyun; Moon, In Seok; Choi, Jae Young

    2014-01-01

    The Vibrant Soundbridge (VSB) with stapes clip coupler placement at the stapes head has been used successfully to treat mixed hearing loss. Coupling between the floating mass transducer of the VSB and the stapes head is technically less demanding than incus vibroplasty and is more likely to generate a positive outcome without significantly changing residual hearing or resulting in medical or surgical complications. A 65-year-old man with bilateral mixed hearing loss and chronic otitis media u...

  1. Measuring the Cost of a College Degree: A Case Study of a SUNY Community College

    Science.gov (United States)

    Romano, Richard M.; Losinger, Regina; Millard, Tim

    2011-01-01

    Inspired by a white paper produced by the Delta Project on Postsecondary Education Costs, Productivity, and Accountability, this study uses different measures of calculating the cost of a college degree at an upstate community college in New York. Departmental cost per credit hour, direct instructional costs, and full costs are all explained. A…

  2. Production costs and operative margins in electric energy generation from biogas. Full-scale case studies in Italy.

    Science.gov (United States)

    Riva, C; Schievano, A; D'Imporzano, G; Adani, F

    2014-08-01

    The purpose of this study was to observe the economic sustainability of three different biogas full scale plants, fed with different organic matrices: energy crops (EC), manure, agro-industrial (Plants B and C) and organic fraction of municipal solid waste (OFMSW) (Plant A). The plants were observed for one year and total annual biomass feeding, biomass composition and biomass cost (€ Mg(-1)), initial investment cost and plant electric power production were registered. The unit costs of biogas and electric energy (€ Sm(-3)biogas, € kWh(-1)EE) were differently distributed, depending on the type of feed and plant. Plant A showed high management/maintenance cost for OFMSW treatment (0.155 € Sm(-3)biogas, 45% of total cost), Plant B suffered high cost for EC supply (0.130 € Sm(-3)biogas, 49% of total cost) and Plant C showed higher impact on the total costs because of the depreciation charge (0.146 € Sm(-3)biogas, 41% of total costs). The breakeven point for the tariff of electric energy, calculated for the different cases, resulted in the range 120-170 € MWh(-1)EE, depending on fed materials and plant scale. EC had great impact on biomass supply costs and should be reduced, in favor of organic waste and residues; plant scale still heavily influences the production costs. The EU States should drive incentives in dependence of these factors, to further develop this still promising sector.

  3. Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report

    OpenAIRE

    2012-01-01

    Abstract Vitamin B12 is one of the essential vitamins affecting various systems of the body. Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old, male adolescent who presented with mixed mood disorder symptoms with psychotic features. Chief complaints were “irritability, regressive behavior, apathy, crying and truancy” which lasted for a year. Premorbid personality was unrema...

  4. A Hybrid Numerical Method for Turbulent Mixing Layers. Degree awarded by Case Western Reserve Univ.

    Science.gov (United States)

    Georgiadis, Nicholas J.

    2001-01-01

    A hybrid method has been developed for simulations of compressible turbulent mixing layers. Such mixing layers dominate the flows in exhaust systems of modern day aircraft and also those of hypersonic vehicles currently under development. The method configurations in which a dominant structural feature provides an unsteady mechanism to drive the turbulent development in the mixing layer. The hybrid method uses a Reynolds-averaged Navier-Stokes (RANS) procedure to calculate wall bounded regions entering a mixing section, and a Large Eddy Simulation (LES) procedure to calculate the mixing dominated regions. A numerical technique was developed to enable the use of the hybrid RANS-LES method on stretched, non-Cartesian grids. Closure for the RANS equations was obtained using the Cebeci-Smith algebraic turbulence model in conjunction with the wall-function approach of Ota and Goldberg. The wall-function approach enabled a continuous computational grid from the RANS regions to the LES region. The LES equations were closed using the Smagorinsky subgrid scale model. The hybrid RANS-LES method is applied to a benchmark compressible mixing layer experiment. Preliminary two dimensional calculations are used to investigate the effects of axial grid density and boundary conditions. Vortex shedding from the base region of a splitter plate separating the upstream flows was observed to eventually transition to turbulence. The location of the transition, however, was much further downstream than indicated by experiments. Actual LES calculations, performed in three spatial directions, also indicated vortex shedding, but the transition to turbulence was found to occur much closer to the beginning of the mixing section. which is in agreement with experimental observations. These calculations demonstrated that LES simulations must be performed in three dimensions. Comparisons of time-averaged axial velocities and turbulence intensities indicated reasonable agreement with experimental

  5. Challenges from Tuberculosis Diagnosis to Care in Community-Based Active Case Finding among the Urban Poor in Cambodia: A Mixed-Methods Study.

    Directory of Open Access Journals (Sweden)

    Natalie Lorent

    Full Text Available While community-based active case finding (ACF for tuberculosis (TB holds promise for increasing early case detection among hard-to-reach populations, limited data exist on the acceptability of active screening. We aimed to identify barriers and explore facilitators on the pathway from diagnosis to care among TB patients and health providers.Mixed-methods study. We administered a survey questionnaire to, and performed in-depth interviews with, TB patients identified through ACF from poor urban settlements in Phnom Penh, Cambodia. Additionally, we conducted focus group discussions and in-depth interviews with community and public health providers involved in ACF, respectively.Acceptance of home TB screening was strong among key stakeholders due to perceived reductions in access barriers and in direct and indirect patient costs. Privacy and stigma were not an issue. To build trust and facilitate communication, the participation of community representatives alongside health workers was preferred. Most health providers saw ACF as complementary to existing TB services; however, additional workload as a result of ACF was perceived as straining operating capacity at public sector sites. Proximity to a health facility and disease severity were the strongest determinants of prompt care-seeking. The main reasons reported for delays in treatment-seeking were non-acceptance of diagnosis, high indirect costs related to lost income/productivity and transportation expenses, and anticipated side-effects from TB drugs.TB patients and health providers considered home-based ACF complementary to facility-based TB screening. Strong engagement with community representatives was believed critical in gaining access to high risk communities. The main barriers to prompt treatment uptake in ACF were refusal of diagnosis, high indirect costs, and anticipated treatment side-effects. A patient-centred approach and community involvement were essential in mitigating barriers

  6. Mixed medullary-papillary carcinoma of the thyroid: report of two cases and review of the literature.

    Science.gov (United States)

    Gurkan, Eren; Gurbuz, Yesim; Tarkun, Ilhan; Canturk, Zeynep; Cetinarslan, Berrin

    2014-01-01

    Papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) are two distinct types of thyroid carcinoma with considerable difference in terms of cellular origin, histopathological appearance, clinical course and prevalence. The histogenetic origin and possible molecular mechanisms responsible for the development of mixed medullary-papillary carcinoma of the thyroid are still unclear. The most widely accepted hypotheses considering co-occurrence of MTC and PTC are stem cell theory, collision effect theory and hostage theory. Herein we describe two rare cases of mixed medullary-papillary thyroid carcinoma with co-occurrence of MTC and PTC which developed with concomitant MEN 2A and different sites of lymph node metastasis in the first patient, while with atypical clinical presentation in the second patient. In conclusion, co-expression of thyroglobulin, synaptophysin and chromogranin by the papillary component of mixed tumor seems to support stem cell theory in our first case, whereas positive staining for calcitonin but not for thyroglobulin in the medullary component of the tumor along with separation of these two tumors from each other by a normal thyroid tissue seem to indicates the likelihood of collision effect theory in our second case.

  7. The external costs of electricity generation. A comparison of environmental damage of silicon photovoltaic electricity, produced with different electricity mixes, vs natural gas and coal

    Energy Technology Data Exchange (ETDEWEB)

    Olson, C.L.; Veltkamp, A.C.; Sinke, W.C. [ECN Solar Energy, Petten (Netherlands)

    2012-09-15

    In this paper the environmental damages of crystalline silicon photovoltaics are calculated, using the most recent photovoltaics data, and compared with those of the prevalent conventional energy technologies. A life cycle assessment of selected environmental impacts of 1kWh of electricity generated by various technologies was performed using Simapro software (version 7.2.4) in conjunction with the Ecoinvent database (version 2.2). The environmental impacts were assessed using the ReCiPe methodology. Because of the important role of coal and natural gas in the global electricity generation portfolio, special attention is given to the comparison of PV with those technologies. The environmental consequences of manufacturing PV modules with renewable, UCTE or 100% coal electricity mixes are explored. A brief update of the estimated monetarization of damages due to coal and climate change is included. A rough estimate of the true cost of coal and PV electricity is made in 2011.

  8. Enrichment of highly settleable microalgal consortia in mixed cultures for effluent polishing and low-cost biomass production.

    Science.gov (United States)

    Hu, Yuansheng; Hao, Xiaodi; van Loosdrecht, Mark; Chen, Huiqin

    2017-08-15

    Microalgae cultivation is a promising technology for integrated effluent polishing and biofuel production, but poor separability of microalgal cells hinders its industrial application. This study intended to selectively enrich settleable microalgal consortia in mixed culture by applying "wash-out" pressure, which was realized by controlling settling time (ST) and volume exchange ratio (VER) in photo-SBRs. The results demonstrated that highly settleable microalgal consortia (settling efficiency>97%; SVI = 17-50 mL/g) could be enriched from indigenous algal cultures developed in WWTP's effluent. High VER was the key factor for the fast development of settleable microalgae. VER was also a controlling factor of the algal community structure. High VERs (0.5 and 0.7) resulted in the dominance of diatom, while low VER (0.2) facilitated the dominance of cyanobacteria. The settleable microalgal consortia were very efficient in phosphorus removal (effluent PO4(3-)-P99%), which was largely attributed to intensive chemical precipitation of phosphate induced by high pH (8.5-10). However, the high pH decreased the bioavailable inorganic carbon, resulting in incomplete nitrate removal (effluent NO3(-)-N = 2.2-4 mg/L; removal efficiency = 61-79%) under high VERs and low lipid content (up to 10%) in the settleable microalgae. This problem could be resolved by sparging CO2 or controlling pH. Overall, this study demonstrated a simple and effective method to overcome the separation challenge in scale-up of microalgae biotechnology for advanced wastewater purification and biofuel production. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Uncertainties in early-stage capital cost estimation of process design – a case study on biorefinery design

    DEFF Research Database (Denmark)

    Cheali, Peam; Gernaey, Krist; Sin, Gürkan

    2015-01-01

    is highlighted using the synthesis and design of a biorefinery as a case study. The impact of uncertainties in cost estimation on the identification of optimal processing paths is indeed found to be profound. To tackle this challenge, a comprehensive techno-economic risk analysis framework is presented to enable......Capital investment, next to the product demand, sales, and production costs, is one of the key metrics commonly used for project evaluation and feasibility assessment. Estimating the investment costs of a new product/process alternative during early-stage design is a challenging task, which......) the Monte Carlo technique as an error propagation method based on expert input when cost data are not available. Four well-known models for early-stage cost estimation are reviewed and analyzed using the methodology. The significance of uncertainties of cost data for early-stage process design...

  10. The Role of Marketing Mix Components in Destination Choices of Visitors and the Case of Dalyan

    Directory of Open Access Journals (Sweden)

    Özgür ÖZER

    2012-03-01

    Full Text Available This study investigated the impact of the eight components of the marketing mix, as being product, price, distribution, promotion, person, partnership, program and package, upon choice of a destination.For this research purpose, data was collected by face-to-face interviews and survey from 260 foreign tourists visiting the region of Dalyan. First, the marketing mix components were classified according to their importance determined by the arithmetic averages. Then, multiple regression analysis was performed to determine whether the marketing mix components had an effect on the destination choice. The analysis found that the variables of ‘product’ and ‘person’ had an effect on the Dalyan destination choice. This result shows that the ’product’ is an influencial factor, as expected, on the choice of the Dalyan destination, within the scope of ecotourism, visited by the tourists. In addition, ‘person’ is also important factor on the destination choice for the Dalyan region.

  11. Groundwater flow processes and mixing in active volcanic systems: the case of Guadalajara (Mexico)

    Science.gov (United States)

    Hernández-Antonio, A.; Mahlknecht, J.; Tamez-Meléndez, C.; Ramos-Leal, J.; Ramírez-Orozco, A.; Parra, R.; Ornelas-Soto, N.; Eastoe, C. J.

    2015-09-01

    Groundwater chemistry and isotopic data from 40 production wells in the Atemajac and Toluquilla valleys, located in and around the Guadalajara metropolitan area, were determined to develop a conceptual model of groundwater flow processes and mixing. Stable water isotopes (δ2H, δ18O) were used to trace hydrological processes and tritium (3H) to evaluate the relative contribution of modern water in samples. Multivariate analysis including cluster analysis and principal component analysis were used to elucidate distribution patterns of constituents and factors controlling groundwater chemistry. Based on this analysis, groundwater was classified into four groups: cold groundwater, hydrothermal groundwater, polluted groundwater and mixed groundwater. Cold groundwater is characterized by low temperature, salinity, and Cl and Na concentrations and is predominantly of Na-HCO3-type. It originates as recharge at "La Primavera" caldera and is found predominantly in wells in the upper Atemajac Valley. Hydrothermal groundwater is characterized by high salinity, temperature, Cl, Na and HCO3, and the presence of minor elements such as Li, Mn and F. It is a mixed-HCO3 type found in wells from Toluquilla Valley and represents regional flow circulation through basaltic and andesitic rocks. Polluted groundwater is characterized by elevated nitrate and sulfate concentrations and is usually derived from urban water cycling and subordinately from agricultural return flow. Mixed groundwaters between cold and hydrothermal components are predominantly found in the lower Atemajac Valley. Twenty-seven groundwater samples contain at least a small fraction of modern water. The application of a multivariate mixing model allowed the mixing proportions of hydrothermal fluids, polluted waters and cold groundwater in sampled water to be evaluated. This study will help local water authorities to identify and dimension groundwater contamination, and act accordingly. It may be broadly applicable to

  12. Comfort temperatures inside low-cost housing : case : six warm climate cities in Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Gomez-Azpeitia, G. [Colima Univ., Colima (Mexico). Faculty of Architecture and Design; Bojorquez, G.; Romero, R. [Autonomic Univ. of Baja California, Mexicali (Mexico). Faculty of Architecture and Design; Ruiz, P. [Autonomic Univ. of Chiapas, Tuxtla Gutierrez (Mexico). Faculty of Architecture; Ochoa, J. [Sonora Univ., Hermosillo (Mexico). School of Architecture; Perez, M. [Autonomic Univ. of Yucatan, Merida (Mexico). Faculty of Engineering; Resendiz, O. [Autonomic Univ. of Baja California Sur, La Paz (Mexico). Dept. of Fishing Engineering; Llamas, A. [Autonomic Univ. of Sinaloa, Culiacan (Mexico). Faculty of Architecture

    2009-07-01

    Mexico's National Council for Housing and National Council for Science and Technology supported a research project on the thermal comfort and energy savings in low-cost housing in Mexico. The objective was to establish thermal comfort models and provide reliable diagnostic tools for architectural designers of low-cost housing. Another objective was to promote energy savings through the adjustment of operative temperatures in air conditioning equipment. The approach of the research was an adaptive one in order to evaluate the thermal sensation of individuals in their own habitat; allow the integral study of both physiological and psychological reactions; and consider the individuals as proactive occupants, in search of their thermal comfort. The results of a field study developed according to the adaptive approach principles were presented in this paper. The survey was carried out from 2006 to 2007 in low-cost housing units in 6 Mexican cities with warm climates. In all cases, the houses were naturally ventilated. The measuring periods were determined according to the climatic characteristics of each city. The results of the field study demonstrated the importance of having standards of thermal comfort specific to each location, which must be defined through the direct response of individuals and in the environment in which they perform their daily activities. The results also showed that in hot climates, acclimated people may find comfort in temperatures around 30 degrees C during the warmest seasons. Therefore, reducing the operating temperatures of air conditioning in such conditions represents a huge opportunity for saving electricity. 16 refs., 6 tabs., 6 figs.

  13. A way for reducing drug supply chain cost for a hospital district: A case study

    Energy Technology Data Exchange (ETDEWEB)

    Postacchini, L.; Ciarapica, F.E.; Bevilacqua, M.; Mazzuto, G.; Paciarotti, C.

    2016-07-01

    This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization); re-order and inventory management policies (Economic Order Quantity or Economic Order Interval); required service levels (90% or 95%); the number of available vans (one or two). For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments) analysis has been executed. The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. This paper fulfils an identified need to study which combination of transshipment policies, re-order/inventory management policies and required service levels, can be the

  14. Case studies: low cost, high-strength, large carbon foam tooling

    Energy Technology Data Exchange (ETDEWEB)

    Lucas, R.; Danford, H. [Touchstone Research Laboratory Ltd., Triadelphia, WV (USA)

    2009-01-15

    A new carbon foam tooling system has been developed that results in a low-cost, high-strength material that has been proving attractive for creation of tooling for composite parts. Composites are stronger; lighter and less subject to corrosion and fatigue than materials that are currently used for fabrication of advanced structures. Tools to manufacture these composite parts must be rigid, durable and able to offer a coefficient of thermal expansion (CTE) closely matching that of the composites. Current technology makes it difficult to match the CTE of a composite part in the curing cycle with anything other than a carbon composite or a nickel iron alloy such as Invar. Fabrication of metallic tooling requires many, expensive stages of long duration with a large infrastructure investment. Card ban fiber reinforced polymer resin composite tooling has a shorter lead-time but limited production use because of durability concerns. Coal-based carbon foam material has a compatible CTE and strong durability, that make it an attractive alternative for use in tooling. The use of coal-based carbon foam in tooling for carbon composites is advantageous because of its low cost, light weight, machinability , vacuum integrity and compatibility with a wide range of curing processes. Large-scale tooling case studies will be presented detailing carbon foam's potential for tooling applications.

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

    Science.gov (United States)

    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.

  16. Allocating Risks in Public-Private Partnerships Using a Transaction Cost Economic Approach: A Case Study

    Directory of Open Access Journals (Sweden)

    Xioa-Hua Jin

    2012-11-01

    Full Text Available Public-private partnership (PPP projects are often characterisedby increased complexity and uncertainty due to their idiosyncrasyin the management and delivery processes such as long-termlifecycle, incomplete contracting, and the multitude of stakeholders.An appropriate risk allocation is particularly crucial to achievingproject success. This paper focuses on the risk allocation in PPPprojects and argues that the transaction cost economics (TCEtheory can integrate the economics part, which is currently missing,into the risk management research. A TCE-based approach isproposed as a logical framework for allocating risks between publicand private sectors in PPP projects. A case study of the SouthernCross Station redevelopment project in Australia is presented toillustrate the approach. The allocation of important risks is putunder scrutiny. Lessons learnt are discussed and alternativemanagement approaches drawing on TCE theory are proposed.

  17. Case Study on Soft Soil Improvement using Innovative and Cost-Effective Reinforcing Techniques

    Directory of Open Access Journals (Sweden)

    Endra Susila

    2015-05-01

    Full Text Available This paper describes, discusses and compares three new innovations of reinforcement systems for soft soils: (a a combination of gridded matrass and piles of bamboo, (b a combination of matrass and piles of bamboo, and (c a group of mini piles connected by small H-beams with a compacted top layer to hold the top mini piles. First, illustrations and applications of the three types of reinforcement are described from three full-scale field works. Technical bases for the three types are presented, while technical comparisons are discussed next. Finally, conclusions are developed. The case studies, analysis results, and full-scale fieldwork verifications show that the three reinforcement systems have worked properly. Each system has its own advantages and disadvantages in terms of construction duration and cost, capability/effectiveness and material availability, especially in rural areas.

  18. Multi-objective Mixed Integer Programming approach for facility layout design by considering closeness ratings, material handling, and re-layout cost

    Science.gov (United States)

    Purnomo, Muhammad Ridwan Andi; Satrio Wiwoho, Yoga

    2016-01-01

    Facility layout becomes one of production system factor that should be managed well, as it is designated for the location of production. In managing the layout, designing the layout by considering the optimal layout condition that supports the work condition is essential. One of the method for facility layout optimization is Mixed Integer Programming (MIP). In this study, the MIP is solved using Lingo 9.0 software and considering quantitative and qualitative objectives to be achieved simultaneously: minimizing material handling cost, maximizing closeness rating, and minimizing re-layout cost. The research took place in Rekayasa Wangdi as a make to order company, focusing on the making of concrete brick dough stirring machine with 10 departments involved. The result shows an improvement in the new layout for 333,72 points of objective value compared with the initial layout. As the conclusion, the proposed MIP is proven to be used to model facility layout problem under multi objective consideration for a more realistic look.

  19. The Role of Leadership and Culture in Creating Meaningful Assessment: A Mixed Methods Case Study

    Science.gov (United States)

    Guetterman, Timothy C.; Mitchell, Nancy

    2016-01-01

    With increased demands for institutional accountability and improved student learning, involvement in assessment has become a fundamental role of higher education faculty (Rhodes, 2010). However, faculty members and administrators often question whether assessment efforts do indeed improve student learning (Hutchings, 2010). This mixed methods…

  20. Groundwater flow processes and mixing in active volcanic systems: the case of Guadalajara (Mexico

    Directory of Open Access Journals (Sweden)

    A. Hernández-Antonio

    2015-02-01

    Full Text Available Groundwater chemistry and isotopic data from 40 production wells in the Atemajac and Toluquilla Valleys, located in and around the Guadalajara metropolitan area, were determined to develop a conceptual model of groundwater flow processes and mixing. Multivariate analysis including cluster analysis and principal component analysis were used to elucidate distribution patterns of constituents and factors controlling groundwater chemistry. Based on this analysis, groundwater was classified into four groups: cold groundwater, hydrothermal water, polluted groundwater and mixed groundwater. Cold groundwater is characterized by low temperature, salinity, and Cl and Na concentrations and is predominantly of Na-HCO3 type. It originates as recharge at Primavera caldera and is found predominantly in wells in the upper Atemajac Valley. Hydrothermal water is characterized by high salinity, temperature, Cl, Na, HCO3, and the presence of minor elements such as Li, Mn and F. It is a mixed HCO3 type found in wells from Toluquilla Valley and represents regional flow circulation through basaltic and andesitic rocks. Polluted groundwater is characterized by elevated nitrate and sulfate concentrations and is usually derived from urban water cycling and subordinately from agricultural practices. Mixed groundwaters between cold and hydrothermal components are predominantly found in the lower Atemajac Valley. Tritium method elucidated that practically all of the sampled groundwater contains at least a small fraction of modern water. The multivariate mixing model M3 indicates that the proportion of hydrothermal fluids in sampled well water is between 13 (local groundwater and 87% (hydrothermal water, and the proportion of polluted water in wells ranges from 0 to 63%. This study may help local water authorities to identify and quantify groundwater contamination and act accordingly.

  1. 73 Activity Based Costing and Product Pricing Decision: the Nigerian Case

    OpenAIRE

    Ebipanipre Gabriel Mieseigha

    2014-01-01

    This paper examined activity based costing and product pricing decisions in Nigeria so as to ascertain whether activity based costing have the ability to enhance profitability and control cost of manufacturing firms. Towards this end, a multiple correlation and regression estimation technique was used in analyzing the data obtained in the study. The study found that activity based costing affects product costing and pricing decision. In addition, the results showed that improved ...

  2. Primary malignant mixed müllerian tumor of the peritoneum a case report with review of the literature

    Directory of Open Access Journals (Sweden)

    Gashi-Luci Lumturije

    2011-02-01

    Full Text Available Abstract Malignant mixed Müllerian tumor is a rare malignancy of the genital tract and extremely uncommon in extragenital sites. This report describes a case of malignant mixed Müllerian tumor arising in the lower peritoneum of a 72-year-old female patient. The patient presented with ascites, lower abdominal mass and pleural effusion. The serum level of CA125 was elevated. At operation a diffuse carcinosis associated with tumor mass measuring 20 × 15 × 10 cm in the vesicouterine and Duglas' pouch were found. The uterus and the adnexa were unremarkable. Histopathology revealed a typical malignant mixed Müllerian tumor, heterologous type. The epithelial component was positive for cytokeratin 7 and vimentin whereas the mesenchymal component was positive for Vimentin, S100 and focally for CK7. The histogenesis of this tumor arising from the peritoneum is still speculative. Based on the previous reports and the immunohistochemical analysis of our case, we believe that this is a monoclonal tumor with carcinoma being the "precursor" element. Nevertheless, further molecular and genetic evidence is needed to support such a conclusion.

  3. Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model

    Directory of Open Access Journals (Sweden)

    Khanassov V

    2014-06-01

    Full Text Available Vladimir Khanassov, Isabelle Vedel, Pierre PluyeDepartment of Family Medicine, McGill University, Montreal, QC, CanadaBackground: The purpose of this study was to examine factors associated with the implementation of case management (CM interventions in primary health care (PHC and to develop strategies to enhance its adoption by PHC practices.Methods: This study was designed as a systematic mixed studies review (including quantitative and qualitative studies with synthesis based on the diffusion of innovation model. A literature search was performed using MEDLINE, PsycInfo, EMBASE, and the Cochrane Database (1995 to August 2012 to identify quantitative (randomized controlled and nonrandomized and qualitative studies describing the conditions limiting and facilitating successful CM implementation in PHC. The methodological quality of each included study was assessed using the validated Mixed Methods Appraisal Tool. Results: Twenty-three studies (eleven quantitative and 12 qualitative were included. The characteristics of CM that negatively influence implementation are low CM intensity (eg, infrequent follow-up, large caseload (more than 60 patients per full-time case manager, and approach, ie, reactive rather than proactive. Case managers need specific skills to perform their role (eg, good communication skills and their responsibilities in PHC need to be clearly delineated.Conclusion: Our systematic review supports a better understanding of factors that can explain inconsistent evidence with regard to the outcomes of dementia CM in PHC. Lastly, strategies are proposed to enhance implementation of dementia CM in PHC. Keywords: systematic mixed studies review, dementia, case management, primary health care, implementation, diffusion of innovation

  4. Evaluating the cost of adult voluntary medical male circumcision in a mixed (surgical and PrePex site compared to a hypothetical PrePex-only site in South Africa

    Directory of Open Access Journals (Sweden)

    Hae-Young Kim

    2015-12-01

    Full Text Available Background: Several circumcision devices have been evaluated for a safe and simplified male circumcision among adults. The PrePex device was prequalified for voluntary male medical circumcision (VMMC in May 2013 by the World Health Organization and is expected to simplify the procedure safely while reducing cost. South Africa is scaling up VMMC. Objective: To evaluate the overall unit cost of VMMC at a mixed site vs. a hypothetical PrePex-only site in South Africa. Design: We evaluated the overall unit cost of VMMC at a mixed site where PrePex VMMC procedure was added to routine forceps-guided scalpel-based VMMC in Soweto, South Africa. We abstracted costs and then modeled these costs for a hypothetical PrePex-only site, at which 9,600 PrePex circumcisions per year could be done. We examined cost drivers and modeled costs, varying the price of the PrePex device. The healthcare system perspective was used. Results: In both sites, the main contributors of cost were personnel and consumables. If 10% of all VMMC were by PrePex at the mixed site, the overall costs of the surgical method and PrePex were similar – US$59.62 and $59.53, respectively. At the hypothetical PrePex-only site, the unit cost was US$51.10 with PrePex circumcisions having markedly lower personnel and biohazardous waste management costs. In sensitivity analysis with the cost of PrePex kit reduced to US$10 and $2, the cost of VMMC was further reduced. Conclusions: Adding PrePex to an existing site did not necessarily reduce the overall costs of VMMC. However, starting a new PrePex-only site is feasible and may significantly reduce the overall cost by lowering both personnel and capital costs, thus being cost-effective in the long term. Achieving a lower cost for PrePex will be an important contributor to the scale-up of VMMC.

  5. Uncertainties in Early Stage Capital Cost Estimation of Process Design – A case study on biorefinery design

    Directory of Open Access Journals (Sweden)

    Gurkan eSin

    2015-02-01

    Full Text Available Capital investment, next to the product demand, sales and production costs, is one of the key metrics commonly used for project evaluation and feasibility assessment. Estimating the investment costs of a new product/process alternative during early stage design is a challenging task. This is especially important in biorefinery research, where available information and experiences with new technologies is limited. A systematic methodology for uncertainty analysis of cost data is proposed that employs (a Bootstrapping as a regression method when cost data is available and (b the Monte Carlo technique as an error propagation method based on expert input when cost data is not available. Four well-known models for early stage cost estimation are reviewed an analyzed using the methodology. The significance of uncertainties of cost data for early stage process design is highlighted using the synthesis and design of a biorefinery as a case study. The impact of uncertainties in cost estimation on the identification of optimal processing paths is found to be profound. To tackle this challenge, a comprehensive techno-economic risk analysis framework is presented to enable robust decision making under uncertainties. One of the results using an order-of-magnitude estimate shows that the production of diethyl ether and 1,3-butadiene are the most promising with economic risks of 0.24 MM$/a and 4.6 MM$/a due to uncertainties in cost estimations, respectively.

  6. Mixed Cutaneous Infection Caused by Mycobacterium szulgai and Mycobacterium intermedium in a Healthy Adult Female: A Rare Case Report.

    Science.gov (United States)

    Singh, Amresh Kumar; Marak, Rungmei S K; Maurya, Anand Kumar; Das, Manaswini; Nag, Vijaya Lakshmi; Dhole, Tapan N

    2015-01-01

    Nontuberculous mycobacteria (NTMs) are ubiquitous and are being increasingly reported as human opportunistic infection. Cutaneous infection caused by mixed NTM is extremely rare. We encountered the case of a 46-year-old female, who presented with multiple discharging sinuses over the lower anterior abdominal wall (over a previous appendectomy scar) for the past 2 years. Microscopy and culture of the pus discharge were done to isolate and identify the etiological agent. Finally, GenoType Mycobacterium CM/AS assay proved it to be a mixed infection caused by Mycobacterium szulgai and M. intermedium. The patient was advised a combination of rifampicin 600 mg once daily, ethambutol 600 mg once daily, and clarithromycin 500 mg twice daily to be taken along with periodic follow-up based upon clinical response as well as microbiological response. We emphasize that infections by NTM must be considered in the etiology of nonhealing wounds or sinuses, especially at postsurgical sites.

  7. Mixing heights over hilly terrain - a case study in northern austria

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, K. [Central Inst. for Meteorology and Geodynamics, ZAMG, Vienna (Austria)

    1997-10-01

    Simultaneous Sodar measurements (Remtech PA2) were conducted from 10 October 1996 to 24 January 1997 at two sites in northern Austria, near the village Allensteig on top of a hill (590 m.s.l.) and in the village Lenzing (460 m.s.l.) near the lake Attersee. The two sites are 145 km apart from each other and differ much according to the complexity of the surrounding terrain, land use and altitude. Mixing height and inversions height estimations from the Sodar measurements are compared with mixing heights derived from radiosonde potential temperature profiles at the next stations Linz and Vienna using the parcel method of Stull (1991) explained by M. Piringer (this volume). The information about the static stability at different Sodar heights, which is provided by the new Sodar software in terms of vertical temperature gradients, is discussed. (au)

  8. MIXED HYALINE VASCULAR AND PLASMA CELL TYPE CASTLEMAN’S DISEASE: REPORT OF A CASE

    Directory of Open Access Journals (Sweden)

    F. Asgarani

    2006-05-01

    Full Text Available Castleman’s disease (angiofollicular lymphoid hyperplasia includes a heterogeneous group of lymphoproliferative disorders. The cause of this disease remains uncertain. There are two types of localized Castleman’s disease: the more common hyaline vascular and the plasma cell types. Mixed variant is an uncommon localized lesion in general population. The lesions can occur in any part of the body that contains lymphoid tissue, although seventy percent are found in the anterior mediastinum. We report a thirty years old boy with Castleman’s disease who presented with fever, anorexia, weight loss,sweating, anemia and abdominal mass. The histologic examination of the biopsy specimens revealed a mixed hyaline vascular and plasma cell type of Castleman’s disease.

  9. Mechatronics Engineers’ Perception of Code Mixing: Philadelphia University and Hashemite University as a Case Study

    Directory of Open Access Journals (Sweden)

    Mustafa Al-Khawaldeh

    2016-11-01

    Full Text Available It has recently been widely recognized that code-switching is prevalent in Jordanians' daily conversation in various situations such as home, cafés, universities, restaurants and clubs. Abalhassan and Alshalawi (2000: 183 made a very related observation on code switching behavior among Arab speakers of English that “without exception, all respondents switched into English to some degree”. This could be referred to the increase number of technological advances and people travelling across countries for pleasure or for pursuing further education. In light of this observation, the crucial role of language in people's life, ambivalent attitudes towards code-switching (Akbar, 2007, the dearth of research in this area, such a present study is required to explore Jordanian university students’ and instructors’ perceptions of code-switching in their daily classroom conversation and its expected impact on their language proficiency. In particular, it investigates the factors leading them to code mix and their underlying attitudes towards its expected future impact on their language proficiency. To the best knowledge of the present researcher, this study is the first of its kind in Jordan. Data was collected via semi-structured interviews and a questionnaire from 70 university students and 30 instructors from both Philadelphia University and the Hashemite University. Data revealed that code mixing between English and Arabic is a common phenomenon in lectures they have attended in their academic institutions. The participants also show that they find code mixing fascinating and believe that though code switching might have a positive impact on their learning as it helps them better understand the topic. The instructors revealed that code mixing fulfill a set of functions that serve the educational process.   Keywords: Arabic-English codeswitching, language attitude, bilingualism, language proficiency

  10. Case-Based Reasoning in Mixed Paradigm Settings and with Learning

    Science.gov (United States)

    1994-04-30

    concerning the use of CBR in a mixed paradigm setting in several blackboard-based systems: GBB- CABARET , ABISS, and particularly, FRANK. Our goal was to...tasks. GBB- CABARET and ABISS During the first year of this project, we built two precursors to FRANK. Both were built in the Blackboard Development (GBB...environment. GBB- CABARET was a variant of our previous CABARET system [Rissland & Skalak, 19911. (Work on CABARET was supported under previous

  11. Sublingual-oral rush desensitization to mixed cow and sheep milk: a case report.

    Science.gov (United States)

    Nucera, E; Schiavino, D; Buonomo, A; Pollastrini, E; Altomonte, G; Pecora, V; Decinti, M; Lombardo, C; Patriarca, G

    2008-01-01

    We attempted an oral rush desensitization with mixed cow and sheep milk in a 6-year-old boy who had had adverse reactions to cow and goat milks. Skin prick tests and specific immunoglobulin (Ig) E to cow, sheep and goat milks were positive. The double-blind, placebo-controlled food challenge with cow milk was positive too. He underwent a 12-day sublingual-oral desensitization treatment with mixed cow and sheep milk. Specific IgE and IgG4 were measured. Open oral challenges with cow milk, sheep milk and sheep cheeses were also performed after the desensitization. At the end of the desensitizing treatment our patient could tolerate 120 mL of mixed milk. Specific IgE levels did not vary, whereas an increase of specific IgG4 concentrations was observed. Open oral challenges with cow and sheep milks and sheep cheeses were negative. Oral rush desensitization may represent an alternative approach to the treatment of food allergy in children.

  12. The economics of gasoline subsidy cost reduction policy: Case study of Indonesia

    Science.gov (United States)

    Akimaya, Muhammad I.

    A gasoline subsidy distorts the gasoline market with the resulting inefficiencies and takes substantial revenues that arguably could be spent elsewhere with a better impact on economic growth. Governments with such subsidies are aware of their cost yet face difficulties in removing the policy because of strong resistance from the public. This thesis discusses in three essays the problem faced by the government in removing the gasoline subsidy and provides an alternative policy in reducing the subsidy cost applied to the case of Indonesia. In the first essay, we examine the decision-making process from the government's perspective that has an objective of generating savings to fund other programs while maintaining political power, and the influence that the general population has over the decision. Despite the immense literature on political power, there has yet to be any research that mathematically models the decision-making process of a government with influences from the general population. Under the benchmark scenario, the equilibrium strategy is to keep the subsidy intact. However, the results are found to be very sensitive to the magnitude of the shift in political power as well as the preferences of both the government and the people. In the second essay, we estimate the cross-price elasticity of regular gasoline with respect to premium gasoline price. The importance of such knowledge is to accurately determine the impact of fuel pricing policy that tends to have different rates of tax or subsidy depending on the grade of gasoline. Using data on the Mexican gasoline market, regular gasoline demand is estimated with an Autoregressive Distributed Lag (ARDL) model. Endogeneity of the price and structural break are also investigated. The cross-price elasticities between regular and premium gasoline is found to be -0.895, which confirms high substitutability among gasoline with different grades. In the third essay, we look at the unique case of Indonesia that

  13. Managing Hotel’s Operation in Viet Nam in Global Economic Crisis : A case study on cost reduction in hotel

    OpenAIRE

    Nguyen, Son

    2011-01-01

    The aim of the research for this thesis is to find out the costs which can be reduced in hotels in Vietnam to copes with difficulties and challenges from the global economic crisis. The idea is to find out what kinds of cost can be reduced and how they are reduced to minimize expenditures of hotel, how the costs reduction affect quality of hotel’s products and services. In order to achieve goals of the research, two structure telephone interviews were conducted in a case study in the Huu Ngh...

  14. Active case detection in national visceral leishmaniasis elimination programs in Bangladesh, India, and Nepal: feasibility, performance and costs

    Directory of Open Access Journals (Sweden)

    Huda M

    2012-11-01

    Full Text Available Abstract Background Active case detection (ACD significantly contributes to early detection and treatment of visceral leishmaniasis (VL and post kala-azar dermal leishmaniasis (PKDL cases and is cost effective. This paper evaluates the performance and feasibility of adapting ACD strategies into national programs for VL elimination in Bangladesh, India and Nepal. Methods The camp search and index case search strategies were piloted in 2010-11 by national programs in high and moderate endemic districts / sub-districts respectively. Researchers independently assessed the performance and feasibility of these strategies through direct observation of activities and review of records. Program costs were estimated using an ingredients costing method. Results Altogether 48 camps (Bangladesh-27, India-19, Nepal-2 and 81 index case searches (India-36, Nepal-45 were conducted by the health services across 50 health center areas (Bangladesh-4 Upazillas, India-9 PHCs, Nepal-37 VDCs. The mean number of new case detected per camp was 1.3 and it varied from 0.32 in India to 2.0 in Bangladesh. The cost (excluding training costs of detecting one new VL case per camp varied from USD 22 in Bangladesh, USD 199 in Nepal to USD 320 in India. The camp search strategy detected a substantive number of new PKDL cases. The major challenges faced by the programs were inadequate preparation, time and resources spent on promoting camp awareness through IEC activities in the community. Incorrectly diagnosed splenic enlargement at camps probably due to poor clinical examination skills resulted in a high proportion of patients being subjected to rK39 testing. Conclusion National programs can adapt ACD strategies for detection of new VL/PKDL cases. However adequate time and resources are required for training, planning and strengthening referral services to overcome challenges faced by the programs in conducting ACD.

  15. A way for reducing drug supply chain cost for a hospital district: A case study

    Directory of Open Access Journals (Sweden)

    Leonardo Postacchini

    2016-03-01

    Full Text Available Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization; re-order and inventory management policies (Economic Order Quantity or Economic Order Interval; required service levels (90% or 95%; the number of available vans (one or two. For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments analysis has been executed. Findings: The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. Practical implications: This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. Originality/value: This paper fulfils an identified need to study which combination of

  16. Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model.

    Science.gov (United States)

    Khanassov, Vladimir; Vedel, Isabelle; Pluye, Pierre

    2014-01-01

    The purpose of this study was to examine factors associated with the implementation of case management (CM) interventions in primary health care (PHC) and to develop strategies to enhance its adoption by PHC practices. This study was designed as a systematic mixed studies review (including quantitative and qualitative studies) with synthesis based on the diffusion of innovation model. A literature search was performed using MEDLINE, PsycInfo, EMBASE, and the Cochrane Database (1995 to August 2012) to identify quantitative (randomized controlled and nonrandomized) and qualitative studies describing the conditions limiting and facilitating successful CM implementation in PHC. The methodological quality of each included study was assessed using the validated Mixed Methods Appraisal Tool. Twenty-three studies (eleven quantitative and 12 qualitative) were included. The characteristics of CM that negatively influence implementation are low CM intensity (eg, infrequent follow-up), large caseload (more than 60 patients per full-time case manager), and approach, ie, reactive rather than proactive. Case managers need specific skills to perform their role (eg, good communication skills) and their responsibilities in PHC need to be clearly delineated. Our systematic review supports a better understanding of factors that can explain inconsistent evidence with regard to the outcomes of dementia CM in PHC. Lastly, strategies are proposed to enhance implementation of dementia CM in PHC.

  17. Low cost monitoring from space using Landsat TM time series and open source technologies: the case study of Iguazu park

    Science.gov (United States)

    Nole, Gabriele; Lasaponara, Rosa

    2015-04-01

    Up to nowadays, satellite data have become increasingly available, thus offering a low cost or even free of charge unique tool, with a great potential for operational monitoring of vegetation cover, quantitative assessment of urban expansion and urban sprawl, as well as for monitoring of land use changes and soil consumption. This growing observational capacity has also highlighted the need for research efforts aimed at exploring the potential offered by data processing methods and algorithms, in order to exploit as much as possible this invaluable space-based data source. The work herein presented concerns an application study on the monitoring of vegetation cover and urban sprawl conducted with the use of satellite Landsat TM data. The selected test site is the Iguazu park highly significant, being it one of the most threatened global conservation priorities (http://whc.unesco.org/en/list/303/). In order to produce synthetic maps of the investigated areas to monitor the status of vegetation and ongoing subtle changes, satellite Landsat TM data images were classified using two automatic classifiers, Maximum Likelihood (MLC) and Support Vector Machines (SVMs) applied by changing setting parameters, with the aim to compare their respective performances in terms of robustness, speed and accuracy. All process steps have been developed integrating Geographical Information System and Remote Sensing, and adopting free and open source software. Results pointed out that the SVM classifier with RBF kernel was generally the best choice (with accuracy higher than 90%) among all the configurations compared, and the use of multiple bands globally improves classification. One of the critical elements found in the case of monitoring of urban area expansion is given by the presence of urban garden mixed with urban fabric. The use of different configurations for the SVMs, i.e. different kernels and values of the setting parameters, allowed us to calibrate the classifier also to

  18. The cost of dementia in an unequal country: The case of Chile

    Science.gov (United States)

    Hojman, Daniel A.; Duarte, Fabian; Ruiz-Tagle, Jaime; Budnich, Marilu; Delgado, Carolina; Slachevsky, Andrea

    2017-01-01

    We study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES). We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver’s burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests); direct social costs (social service, daycare); and indirect costs (mostly associated to informal care). The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver’s burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559) is lower in comparison to high-income countries (US$ 39,595) and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent). SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality. PMID:28267795

  19. The cost of dementia in an unequal country: The case of Chile.

    Science.gov (United States)

    Hojman, Daniel A; Duarte, Fabian; Ruiz-Tagle, Jaime; Budnich, Marilu; Delgado, Carolina; Slachevsky, Andrea

    2017-01-01

    We study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES). We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver's burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests); direct social costs (social service, daycare); and indirect costs (mostly associated to informal care). The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver's burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559) is lower in comparison to high-income countries (US$ 39,595) and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent). SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality.

  20. Cost of Managing Waste in Contingency Operations: A Case Study from Bagram Air Force Base, Afghanistan

    Science.gov (United States)

    2011-09-01

    Local Resale Markets • On-Site Reuse /Composting • On-Site Incineration (all types) and/or Containerized Burn (solid) • On-Site Landfills (with liners...Transport Treatment: Blackwater:Yes Greywater : No Disposal: Local River 6 Cost Components Cost Component Cost Drivers Infrastructure Facility type (e.g

  1. 77 FR 76939 - Defense Federal Acquisition Regulation Supplement: Definition of Cost or Pricing Data (DFARS Case...

    Science.gov (United States)

    2012-12-31

    ... 0750-AH49 Defense Federal Acquisition Regulation Supplement: Definition of Cost or Pricing Data (DFARS... consistency with FAR changes addressing the definition of cost or pricing data which clarified the distinction... the DFARS to update the text addressing the definition of cost or pricing data by inserting the...

  2. Comparing the Cost-Effectiveness of Simulation Modalities: A Case Study of Peripheral Intravenous Catheterization Training

    Science.gov (United States)

    Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

    2014-01-01

    While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three…

  3. 73 Activity Based Costing and Product Pricing Decision: the Nigerian Case

    Directory of Open Access Journals (Sweden)

    Ebipanipre Gabriel Mieseigha

    2014-06-01

    Full Text Available This paper examined activity based costing and product pricing decisions in Nigeria so as to ascertain whether activity based costing have the ability to enhance profitability and control cost of manufacturing firms. Towards this end, a multiple correlation and regression estimation technique was used in analyzing the data obtained in the study. The study found that activity based costing affects product costing and pricing decision. In addition, the results showed that improved profitability and cost control can be achieved by implementing activity based costing approach by manufacturing firms. The implication is that traditional costing approach fails in many pricing situations by arbitrarily allocating indirect cost and activity based costing helps in allocating indirect cost accurately. Thus, it was recommended amongst others that activity based costing need to be practiced, maintained and implemented by manufacturing firms since it has a broad range of uses for a wide variety of company functions and operations in the area of process analysis, strategy support, time-based accounting, monitoring wastage, as well as quality and productivity management.

  4. A rare case of mixed connective tissue disease presenting with central nervous system glioma, vasculitis and polymyositis

    Directory of Open Access Journals (Sweden)

    Rushabh Parikh

    2015-12-01

    Full Text Available Mixed connective tissue disease (MCTD was first recognized by Sharp and Colleagues in 1972 among a group of patients with overlapping clinical features of systemic lupus erythematosis (SLE, scleroderma and myositis, with the presence of distinctive antibodies against, what now is known to be U1-ribonucleoprotein (RNP. We report an unusual case of a 23-year old female with MCTD characterized by the coexistence of signs, symptoms and immunological features of 3 defined autoimmune diseases SLE, systemic sclerosis (SSc, polymyositis (PM and an unusual presence of central nervous system (CNS Glioma. [Int J Res Med Sci 2015; 3(12.000: 3917-3920

  5. Cost comparison between private and public collection of residual household waste: Multiple case studies in the Flemish region of Belgium

    Energy Technology Data Exchange (ETDEWEB)

    Jacobsen, R., E-mail: ray.jacobsen@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium); Buysse, J., E-mail: j.buysse@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium); Gellynck, X., E-mail: xavier.gellynck@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium)

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer The goal is to compare collection costs for residual household waste. Black-Right-Pointing-Pointer We have clustered all municipalities in order to find mutual comparable pairs. Black-Right-Pointing-Pointer Each pair consists of one private and one public operating waste collection program. Black-Right-Pointing-Pointer All cases show that private service has lower costs than public service. Black-Right-Pointing-Pointer Municipalities were contacted to identify the deeper causes for the waste management program. - Abstract: The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private.

  6. Quantifying the total cost of infrastructure to enable environmentally preferable decisions: the case of urban roadway design

    Science.gov (United States)

    Gosse, Conrad A.; Clarens, Andres F.

    2013-03-01

    Efforts to reduce the environmental impacts of transportation infrastructure have generally overlooked many of the efficiencies that can be obtained by considering the relevant engineering and economic aspects as a system. Here, we present a framework for quantifying the burdens of ground transportation in urban settings that incorporates travel time, vehicle fuel and pavement maintenance costs. A Pareto set of bi-directional lane configurations for two-lane roadways yields non-dominated combinations of lane width, bicycle lanes and curb parking. Probabilistic analysis and microsimulation both show dramatic mobility reductions on road segments of insufficient width for heavy vehicles to pass bicycles without encroaching on oncoming traffic. This delay is positively correlated with uphill grades and increasing traffic volumes and inversely proportional to total pavement width. The response is nonlinear with grade and yields mixed uphill/downhill optimal lane configurations. Increasing bicycle mode share is negatively correlated with total costs and emissions for lane configurations allowing motor vehicles to safely pass bicycles, while the opposite is true for configurations that fail to facilitate passing. Spatial impacts on mobility also dictate that curb parking exhibits significant spatial opportunity costs related to the total cost Pareto curve. The proposed framework provides a means to evaluate relatively inexpensive lane reconfiguration options in response to changing modal share and priorities. These results provide quantitative evidence that efforts to reallocate limited pavement space to bicycles, like those being adopted in several US cities, could appreciably reduce costs for all users.

  7. THE CHINESE ARE COMING! WHAT TO DO WITH MY MARKETI NG MIX? THE CASE OF RAMADHES & CIA LTDA.

    Directory of Open Access Journals (Sweden)

    João Batista Soares Neto

    2014-03-01

    Full Text Available This case, based on real facts, describes the market situation experienced by Rodrigo Ramadhes, the director of Ramadhes & Cia Ltda., a company based in Minas Gerais that has been operating for more than 60 years. It is one of the leading producers of belts, backpacks and handbags in South America. During the 2000s, the company developed the Madhes belt line as part of its range of accessories, which became its main product. Much of this success was credited to the marketing mix policies, which combined the price, distribution channel and a mixture of communication with brand concept based on functional attributes and benefits. According of the marketing mix, the scenario was favorable for the Madhes line, but growing gdp and increasing penetration of Chinese products, including belts, concerned Rodrigo Ramadhes, who began to consider transferring the company’s industrial production from Minas Gerais to China in pursuit of a greater competitive edge. He constantly reflected on the possible implications of such a move on the company’s marketing mix, despite the current situation being favorable, solid and promising in market terms.

  8. Costs of water treatment due to diminished water quality: A case study in Texas

    Science.gov (United States)

    Dearmont, David; McCarl, Bruce A.; Tolman, Deborah A.

    1998-04-01

    The cost of municipal water treatment due to diminished water quality represents an important component of the societal costs of water pollution. Here the chemical costs of municipal water treatment are expressed as a function of raw surface water quality. Data are used for a 3-year period for 12 water treatment plants in Texas. Results show that when regional raw water contamination is present, the chemical cost of water treatment is increased by 95 per million gallons (per 3785 m3) from a base of 75. A 1% increase in turbidity is shown to increase chemical costs by 0.25%.

  9. Time, costs and farmers’ perceptions: The case of livestock service delivery in tamilnadu

    Directory of Open Access Journals (Sweden)

    G kathiravan

    2011-10-01

    Full Text Available A study was undertaken in southern peninsular State of India, the Tamil Nadu State, (i to ascertain the time costs of animal health care and bovine breeding services, and (ii to comprehend the perceptions of farmers on the livestock services rendered by different service providers. The districts of the state were categorized as 'Livestock Developed' (LD and 'Livestock Under Developed' (LUD based on initial base line developed. Travel, waiting and service time were among the primary non-price factors that affected service quality. Average travel time was highest for visiting the public veterinary centre in both LUD (23.05 min. and LD (21.32 min. districts. Waiting time with regard to veterinarians providing home services in LUD districts was highest (23.01 min., followed by public veterinary centre services at LUD districts (22.35 min., home services by para-veterinarians (22.01 min. and public veterinary centre services at LD districts (20.10 min.. Both travel and waiting time were much higher in case of breeding services compared to curative services, which could be due to the fact that the farmers preferred Artificial Insemination (AI over its close substitute, the natural service. However, the service time was relatively less in case of insemination services vis-à-vis curative services both in LUD and LD districts. The quality perceptions of farmers on livestock services revealed that the home services rendered by veterinarians as the best one (0.83, followed by private veterinary clinics (0.75, home services by para-veterinarians (0.74, public veterinary centres (0.64 and co-operative veterinary centres (0.48. [Vet. World 2011; 4(5.000: 209-212

  10. The costs and effects of a nationwide insecticide-treated net programme: the case of Malawi

    Directory of Open Access Journals (Sweden)

    Ortiz Juan

    2005-05-01

    Full Text Available Abstract Background Insecticide-treated nets (ITNs are a proven intervention to reduce the burden of malaria, yet there remains a debate as to the best method of ensuring they are universally utilized. This study is a cost-effectiveness analysis of an intervention in Malawi that started in 1998, in Blantyre district, before expanding nationwide. Over the 5-year period, 1.5 million ITNs were sold. Methods The costs were calculated retrospectively through analysis of expenditure data. Costs and effects were measured as cost per treated-net year (cost/TNY and cost per net distributed. Results The mean cost/TNY was calculated at $4.41, and the mean cost/ITN distributed at $2.63. It also shows evidence of economies of scale, with the cost/TNY falling from $7.69 in year one (72,196 ITN to $3.44 in year five (720,577 ITN. Cost/ITN distributed dropped from $5.04 to $1.92. Conclusion Combining targeting and social marketing has the potential of being both cost-effective and capable of achieving high levels of coverage, and it is possible that increasing returns to scale can be achieved.

  11. IDC Reengineering Phase 2 & 3 Rough Order of Magnitude (ROM) Cost Estimate Summary (Leveraged NDC Case).

    Energy Technology Data Exchange (ETDEWEB)

    Harris, James M.; Prescott, Ryan; Dawson, Jericah M.; Huelskamp, Robert M.

    2014-11-01

    Sandia National Laboratories has prepared a ROM cost estimate for budgetary planning for the IDC Reengineering Phase 2 & 3 effort, based on leveraging a fully funded, Sandia executed NDC Modernization project. This report provides the ROM cost estimate and describes the methodology, assumptions, and cost model details used to create the ROM cost estimate. ROM Cost Estimate Disclaimer Contained herein is a Rough Order of Magnitude (ROM) cost estimate that has been provided to enable initial planning for this proposed project. This ROM cost estimate is submitted to facilitate informal discussions in relation to this project and is NOT intended to commit Sandia National Laboratories (Sandia) or its resources. Furthermore, as a Federally Funded Research and Development Center (FFRDC), Sandia must be compliant with the Anti-Deficiency Act and operate on a full-cost recovery basis. Therefore, while Sandia, in conjunction with the Sponsor, will use best judgment to execute work and to address the highest risks and most important issues in order to effectively manage within cost constraints, this ROM estimate and any subsequent approved cost estimates are on a 'full-cost recovery' basis. Thus, work can neither commence nor continue unless adequate funding has been accepted and certified by DOE.

  12. Transaction costs and technological development: The case of the Danish fruit and vegetable industry

    DEFF Research Database (Denmark)

    Foss, Kirsten

    1996-01-01

    It is argued that technological change can be understood in terms of attempts to reduce transaction costs as well as production costs. Two types of paths of technological development are identified: a production cost minimizing path, and a transac cost minimizing path. The creation of new...... technological opportunites underlying the path of production-cost.minimizing depends on the emergence of problems of optimizing the performance of products and processing technology. The exploitation of su opportunities may easily be interpreted within a production perspective since the economic consequences...... would be reduced production costs. The creation of new technological opportunities within the transaction-costs-minimizing path depends on th continual emergence of problems related to the control of variablility in product quality or performance. The economic consequence from exploiting...

  13. Case-Based Reasoning Method in Cost Estimation of Drilling Wells

    OpenAIRE

    Hossein Shams Mianaei; Seyed Hossein Iranmanesh

    2013-01-01

    Aim of study is the cost estimation of drilling6T8T 6T8Twells6T8T 6T8Tusing6T Case-Based 6TReasoning6T8T (CBR) method which6T8T is created based6T8T 6T8Ton6T8T 6T8Tthe6T8T 6T8Tviewpoint of using presented6T8T 6T8Tsolutions6T8T 6T8Tfor6T8T 6T8Tprevious6T8T 6T8Tsolved6T8T 6T8Tproblems6T8T in order 6T8Tto solve6T8T new 6T8Tsimilar problems6T8T. 6T8TIn companies6T8T 6T8Tor6T8T 6T8Torganizations6T8T which 6T8Tcost estimation, scheduling,6T8T 6T8Tdesign6T8T, planning 6T8Tand project activities6T8T ...

  14. Unit Sizing and Cost Analysis of Renewable Energy based Hybrid Power Generation System - A Case Study

    Directory of Open Access Journals (Sweden)

    Nitin AGARWAL

    2014-01-01

    Full Text Available A simulation model is developed for optimal sizing and analysis of a PV-diesel-battery based hybrid power generation system with the objectives to minimize life cycle cost and CO2 emission, while maintaining the desired system autonomy. A case study of a boy’s hostel in Moradabad district is taken for analysis purposes. It has 91 rooms with a capacity of 3 boys in each room. The decision variables included in the optimization methodology are total PV area, number of PV modules of 600 Wp, diesel generator power, fuel consumption per year and number of 24 V and 150 Ah batteries. The simulation result shows that the PV percentage of 86 % and diesel penetration of 14 % gives the most optimized solution with minimum LCC of $110,547 and average CO2 emission of 28 kg/day. The developed model has been validated by comparing its results with earlier research work.doi:10.14456/WJST.2014.24

  15. Case-Based Reasoning Method in Cost Estimation of Drilling Wells

    OpenAIRE

    Hossein Shams Mianaei; Seyed Hossein Iranmanesh

    2013-01-01

    Aim of study is the cost estimation of drilling6T8T 6T8Twells6T8T 6T8Tusing6T Case-Based 6TReasoning6T8T (CBR) method which6T8T is created based6T8T 6T8Ton6T8T 6T8Tthe6T8T 6T8Tviewpoint of using presented6T8T 6T8Tsolutions6T8T 6T8Tfor6T8T 6T8Tprevious6T8T 6T8Tsolved6T8T 6T8Tproblems6T8T in order 6T8Tto solve6T8T new 6T8Tsimilar problems6T8T. 6T8TIn companies6T8T 6T8Tor6T8T 6T8Torganizations6T8T which 6T8Tcost estimation, scheduling,6T8T 6T8Tdesign6T8T, planning 6T8Tand project activities6T8T ...

  16. The impact of marketing mix elements on brand loyalty: A case study of mobile phone industry

    Directory of Open Access Journals (Sweden)

    Adel Pourdehghan

    2015-05-01

    Full Text Available In today's highly competitive markets, keeping customers and retaining their loyalty is considered crucial in maintaining business. Companies and retailers also need to look for various marketing strategies in order to improve their customers’ loyalty. Having knowledge and skills about marketing is one of the capabilities which is required for success in the competition. In consumable markets, brands are the main points of differentiation between the competitive presentations, thus, they are crucial for the success of the companies. The purpose of this study was to analyze the impact of marketing mix elements on brand loyalty. The present study is applicable in terms of objective and descriptive survey in terms of data collection. To evaluate the model and hypotheses, data collection was carried out through surveying 384 mobile phone users. For data analysis and verification of the model, structural equation modeling approach (SEM and confirmatory factor analysis (CFA were used and based on the results of the path analysis, the relationship between the variables in the model is investigated. Results indicated the positive impact of products elements, distribution channels, and promotional activities on brand loyalty. Also, the findings showed that indexes of satisfaction and trust which are considered as mediating variables between marketing mix and brand loyalty had positive and significant impact on brand loyalty in the mobile phone industry.

  17. MALIGNANT MIXED MULLERIAN TUMOR OF UTERUS IN A DIABETIC PATIENT - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Gireesh V

    2013-11-01

    Full Text Available ABSTRACT: Uterine malignant mixed mullerian tumor (MMMT is an uncommon carcinosarcomatous neoplasm with a highly malignant, biphasic pattern consisting of both epithelial and mesenchymal components. This paper reports the clinical, pathological and immunohistochemical features of MMMT of a diabetic patient. A 56 year - old woman presented with post - menopausal bleeding for eight months. The patient underwent Total Abdominal Hyst erectomy with Bilateral Salpingo - oophorectomy (TAH&BSO with pelvic lymph nodes dissection. In pathologic evaluation, a polypoid solid and grey white mass measuring 3.5 x 3 x 2 cm was identified. Light microscopy showed biphasic pattern of epithelial compo nent with glandular change and sarcomatous elements of spindle cells with cartilage and bone differentiation. Immunohistochemistry was performed on formalin fixed and paraffin embedded tissue with a panel of immunohistochemical markers comprising of cytoke ratin (CK, vimentin and s 100. The epithelial component was reactive for CK. Vimentin, S 100 positivity was seen in stromal and chondroid elements, so the diagnosis of MMMT was confirmed. CONCLUSION: There may be an association between diabetes mellitus and the development of malignant mixed mullerian tumor. Special attention should be paid when attempting to sample the endometrium of these patients

  18. Relating Ground-Based Aerosol Size Distributions and Vertical Mixing: Mexico City and Other Case Studies

    Science.gov (United States)

    Pettibone, A. J.; Eichinger, W.; Schoenfelder, J.; Stanier, C.

    2008-12-01

    In March 2006, during the MILAGRO field campaign in Mexico City, observations at the T0 location could often be characterized by morning conditions with high particle mass concentrations, low mixing heights, and good correlation between particle number and carbon dioxide, indicative that particle number is controlled by primary emissions. Using this correlation between particle number and carbon dioxide, an average number based-emission factor of 3.4 × 1013 #/vehicle-km has been determined. In the afternoon, the CO2 level drops during ventilation of the daily polluted layer, and the coupling between CO2 and particle number breaks down, with particle number sometimes increasing as CO2 decreases. New particle formation events were observed both simultaneous to and separately from the afternoon ventilation. While the distinction between morning conditions dominated by primary emissions and afternoon conditions dominated by mixing and photochemical particle production is particularly strong in Mexico City because of local meteorology and intense sources, we show that this pattern is common to several locations. Furthermore, the observed particle size distribution after ventilation of the nighttime inversion is a weighted average of nocturnal capping inversion and the morning boundary layer. Finally, using a vertically resolved new particle formation model, we test the hypothesis that growth rates (high in Mexico City at up to 15nm per hour) can be influenced by boundary layer growth rates in addition to condensable species concentrations, under certain assumptions about the vertical profile of new particle formation.

  19. Cost control system for real estate development projects in ChinaPart 2:A case study in Chongqing

    Institute of Scientific and Technical Information of China (English)

    夏煦

    2014-01-01

    This paper discusses the background and purpose, and reviews the current situation of the domestic and international cost control theory of real estate development projects, and introduces the research methods. The case study method is used. . The management idea is the summary of management practices, and case study can improve management theory, and in certain sense, can help combining theory with practice. The analysis of practical projects of real estate development, can help clarify theory, and is helpful for grasping theory in practical work and improve actual ability of the real estate development enterprise. Through the case study in Chongqing, the basic situations of real estate in Chongqing are introduced and relevant theory and procedure of cost control are used in the case study.

  20. Is RoAsT tougher than StEAk?: The effect of case mixing on perception of multi-letter graphemes

    Directory of Open Access Journals (Sweden)

    Jelena Havelka

    2010-03-01

    Full Text Available Case mixing is a technique that is used to investigate the perceptual processes involved in visual word recognition. Two experiments examined the effect of case mixing on lexical decision latencies. The aim of these experiments was to establish whether different case mixing patterns would interact with the process of appropriate visual segmentation and phonological assembly in word reading. In the first experiment, case mixing had a greater effect on response times to words when it led to visual disruption of the multi-letter graphemes (MLGs as well as the overall word shape (e.g. pLeAd, compared to when it disrupted overall word shape only (e.g. plEAd. A second experiment replicated this finding with words in which MLGs represent either the vowel (e.g. bOaST vs. bOAst or the consonant sound (e.g. sNaCK vs. sNAcK. These results confirm that case mixing can have different effect depending on the type of orthographic unit that is broken up by the manipulation. They demonstrate that graphemes are units that play an important role in visual word recognition, and that manipulation of their presentation by case mixing will have a significant effect on response latencies to words in a lexical decision task. As such these findings need to be taken into account by the models of visual word recognition.

  1. Toxoplasma gondii Infection and Mixed Anxiety and Depressive Disorder: A Case-Control Seroprevalence Study in Durango, Mexico

    Science.gov (United States)

    Alvarado-Esquivel, Cosme; Sanchez-Anguiano, Luis Francisco; Hernandez-Tinoco, Jesus; Berumen-Segovia, Luis Omar; Torres-Prieto, Yazmin Elizabeth; Estrada-Martinez, Sergio; Perez-Alamos, Alma Rosa; Ortiz-Jurado, Maria Nalleli; Molotla-de-Leon, Gabriel; Beristain Garcia, Isabel; Rabago-Sanchez, Elizabeth; Liesenfeld, Oliver

    2016-01-01

    Background The parasite Toxoplasma gondii (T. gondii) may invade the brain and might induce behavioral changes. We sought to determine the association of T. gondii infection and mixed anxiety and depressive disorder. Methods Through an age- and gender-matched case-control seroprevalence study, we examined 65 patients suffering from mixed anxiety and depressive disorder (WHO ICD-10 code: F41.2) attending in a public hospital of mental health and 260 control subjects without this disorder from the general population. Sera of participants were analyzed for anti-Toxoplasma IgG and IgM antibodies using enzyme-linked immunoassays. Results Fifteen (23.1%) of the 65 patients and 18 (6.9%) of the 260 controls had anti-T. gondii IgG antibodies (odds ratio (OR): 4.03; 95% confidence interval (CI): 1.90 - 8.53; P 150 IU/mL) anti-T. gondii IgG levels was similar in cases and controls (OR: 0.25; 95% CI: 0.05 - 1.06; P = 0.05). Seroprevalence was similar in male cases and controls (P = 1.0); however, seroprevalence was significantly higher in female cases than in female controls (OR: 7.08; 95% CI: 2.83 - 17.67; P < 0.00001). Patients aged 31 - 50 years old had a significantly higher seroprevalence of T. gondii infection than controls of the same age group (OR: 21.04; 95% CI: 5.22 - 84.80; P < 0.00001). Anti-T. gondii IgM antibodies were found in four (26.7%) of the 15 anti-T. gondii IgG seropositive cases and in 10 (55.6%) of the 18 anti-T. gondii IgG seropositive controls (P = 0.15). Conclusions Results support for the first time an association between seropositivity to T. gondii and mixed anxiety and depressive disorder. Further research to confirm this association and to determine the seroepidemiology of T. gondii infection in patients with this disorder is needed. PMID:27298660

  2. Extragonadal mixed germ cell tumor of the right arm: description of the first case in the literature

    Directory of Open Access Journals (Sweden)

    Benali Hicham

    2012-05-01

    Full Text Available Abstract Background Extragonadal localization of germ cell tumors (GCTs is rare; to the best of our knowledge, a location in the soft tissue of the arm has never been previously reported in the literature. Case presentation We report the case of a 37-year-old man who presented with a primary malignant mixed non-seminomatous GCT (teratocarcinoma variety in the right arm, treated by a combination of cisplatin-based chemotherapy and surgery. After 18 months of close follow-up, no locoregional recurrence or distant metastases have been detected. Conclusions A combination of chemotherapy and surgery is the most appropriate treatment strategy for extragonadal GCTs, to ensure both local and systemic control.

  3. A mixed neoplasm of intraosseous hemangioma with an ameloblastoma: a case of collision tumor or a rare variant?

    Directory of Open Access Journals (Sweden)

    Harshvardhan Shridhar Jois

    2011-12-01

    Full Text Available Hemangiomas of the head and neck are considered to be benign tumors of infancy that are characterized by a rapid growth phase with endothelial cell proliferation, followed by gradual involution. Central hemangiomas are a rare occurrence and even rarer are the hybrid tumors of central hemangiomas with odontogenic tumors such as ameloblastomas. This paper reports a case of one such hybrid tumor in a middle aged adult clinical presenting as a mandibular swelling with indistinct mixed radiographic presentation and histopathologically comprising of intimately associated hemangiomatous vascular channels and typical ameloblastic areas. To the authors’ knowledge this is the sixth case of such a hemangiomatous ameloblastoma which has been reported till date.

  4. Phosphaturic mesenchymal tumor, mixed connective tissue variant, of the mandible: Report of a case and review of the literature

    Science.gov (United States)

    Woo, Victoria L.; Landesberg, Regina; Imel, Erik A.; Singer, Steven R.; Folpe, Andrew L.; Econs, Michael J.; Kim, Taeyun; Harik, Lara R.; Jacobs, Thomas P.

    2009-01-01

    Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome that results in renal phosphate wasting with hypophosphatemia. In most cases, the underlying cause of TIO is a small mesenchymal neoplasm that is often difficult to detect, resulting in delayed diagnosis. One such neoplasm is the phosphaturic mesenchymal tumor, mixed connective tissue variant (PMTMCT), an unusual entity with unique morphologic and biochemical features. The majority of these tumors are found at appendicular sites with only rare cases reported in the jaws. We describe a PMTMCT involving the mandible in a patient with a protracted history of osteomalacia. A review of the current literature is provided with emphasis on the clinical and histologic features, etiopathogenesis, and management of PMTMCT in the setting of TIO. PMID:19828339

  5. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...

  6. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...

  7. Strategy towards cost-effective low-temperature solid oxide fuel cells: A mixed-conductive membrane comprised of natural minerals and perovskite oxide

    Science.gov (United States)

    Xia, Chen; Cai, Yixiao; Wang, Baoyuan; Afzal, Muhammad; Zhang, Wei; Soltaninazarlou, Aslan; Zhu, Bin

    2017-02-01

    Our previous work has revealed the feasibility of natural hematite as an electrolyte material for solid oxide fuel cells (SOFCs), tailoring SOFCs to be a more economically competitive energy conversion technology. In the present work, with the aim of exploring more practical uses of natural minerals, a novel composite hematite/LaCePrOx-La0.6Sr0.4Co0.2Fe0.8O3-δ (hematite/LCP-LSCF) has been developed from natural hematite ore, rare-earth mineral LaCePr-carbonate, and perovskite oxide LSCF as a functional membrane in SOFCs. The heterogeneity, nanostructure and mixed-conductive property of the composite were investigated. The results showed that the hematite/LCP-30 wt% LSCF composite possessed balanced ionic and electronic conductivities, with an ionic conductivity as high as 0.153 S cm-1 at 600 °C. The as-designed fuel cell using the hematite/LCP-LSCF membrane exhibited encouraging power outputs of 303 - 662 mW cm-2 at 500 - 600 °C. These findings show that the hematite/LCP-LSCF based fuel cell is a viable strategy for developing cost-effective and practical low-temperature SOFCs (LTSOFCs).

  8. Health economic impacts and cost-effectiveness of aflatoxin reduction strategies in Africa: Case studies in biocontrol and postharvest interventions

    Science.gov (United States)

    Wu, Felicia; Khlangwiset, Pornsri

    2010-01-01

    Advances in health economics have proven useful in evaluating the cost-effectiveness of interventions, where the benefit usually takes the form of improved health outcomes rather than market outcomes. We perform health-based cost-effectiveness analyses of two potential aflatoxin control strategies in Africa: 1) pre-harvest biocontrol, using atoxigenic strains of Aspergillus flavus to competitively exclude toxigenic strains from colonizing maize in Nigeria, and 2) postharvest interventions in a package to reduce aflatoxin accumulation in groundnuts in Guinea. We describe how health benefits gained from each intervention, in terms of fewer aflatoxin-induced hepatocellular carcinoma (HCC) cases, can be compared with costs of implementing the interventions. We find that both interventions would be extremely cost-effective if applied widely in African agriculture. That is, the monetized value of lives saved and quality of life gained by reducing aflatoxin-induced HCC far exceeds the cost of either biocontrol or the postharvest intervention package to achieve those health benefits. The estimated cost-effectiveness ratio (CER; gross domestic product multiplied by disability-adjusted life years saved per unit cost) for biocontrol in Nigerian maize ranges from 5.10 to 24.8; while the estimated CER for the postharvest intervention package in Guinean groundnuts ranges from 0.21 to 2.08. Any intervention with a CER greater than 1 is considered by the World Health Organization to be “very cost-effective,” while an intervention with a CER greater than 0.33 is considered “cost-effective.” Aside from cost-effectiveness, public health interventions must be readily accepted by the public, and must have financial and infrastructural support to be feasible in the parts of the world where they are most needed. PMID:20234965

  9. The Case for Adolescent HIV Vaccination in South Africa: A Cost-Effectiveness Analysis.

    Science.gov (United States)

    Moodley, Nishila; Gray, Glenda; Bertram, Melanie

    2016-01-01

    Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness. The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective. The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values. School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective.

  10. Cost of Poor Quality Analysis for Automobile Industry: A Case Study

    Science.gov (United States)

    Teli, S. N.; Majali, V. S.; Bhushi, U. M.; Gaikwad, L. M.; Surange, V. G.

    2013-10-01

    The high competitiveness makes the quest for production cost reduction a constant in the market, but it is necessary to reduce costs without compromising quality. When a product is in the manufacturing and this has to be scraped, we have more cost than the raw material used, it is necessary to consider the manpower and operations, thus to calculate the cost added to the product. Continuous quality improvement is a key factor in the strategy for competitiveness. Quality cost is one tool, among many others, that can help in continuous quality improvement. Properly applying quality cost techniques is critical to these efforts. Initially, a complete quality cost study could provide awareness and guidance to a steering committee on what cross-discipline teams and improvement projects should be started. The cross discipline teams also can use quality cost special studies to help in focusing efforts. In this paper cost of poor quality analysis has been done using different techniques which are currently applying in automobile industry to assess quality cost.

  11. Mixed odontogenic tumours and odontomas. Considerations on interrelationship. Review of the literature and presentation of 134 new cases of odontomas.

    Science.gov (United States)

    Philipsen, H P; Reichart, P A; Praetorius, F

    1997-03-01

    Based on a world-wide literature survey of published cases of "mixed odontogenic tumours" (ameloblastic fibroma, fibrodentinoma and fibro-odontoma) and complex/compound odontomas (including 134 own cases of odontomas) the authors present data showing the complex nature of these lesions. The authors suggest the following work hypothesis regarding the pathogenesis and relationship between the "mixed odontogenic tumours" and the odontomas. The tumours develop along two separate lines: (I) the neoplastic line comprising only one tumour, the ameloblastic fibroma (AF) and the closely related ameloblastic fibrodentinoma (AFD). (II) The hamartomatous (or the developing complex odontoma (DCO) line comprising: (1) The AF (and AFD). Differences in age and biological behaviour indicate that some AF are true benign neoplasms, whereas others are hamartomas presenting the first stage in the DCO-line. (2) The AF-O represents the second stage of the DCO-line developing into (3) the fully mineralized complex odontoma. Lastly, the authors suggest that the compound odontoma should be considered not as an alternative final stage to the complex odontoma but rather as a malformation (with a high degree of histomorphological differentiation) pathogenetically closely related to the process producing hyperodontia, "multiple schizodontia" or locally conditioned hyperactivity of the dental lamina.

  12. Implications of biomass pretreatment to cost and carbon emissions: case study of rice straw and Pennisetum in Taiwan.

    Science.gov (United States)

    Chiueh, Pei-Te; Lee, Kun-Chou; Syu, Fu-Sians; Lo, Shang-Lien

    2012-03-01

    The purpose of this study was to explore the impact of feedstock collection and torrefaction pretreatment on the efficiency of a biomass co-firing system. Considering the transformation of existing municipal solid waste incinerators, several scenarios in which biomass supply chains depend on centralised pretreatment and transportation alternatives are presented. The cost, net energy output, and greenhouse gas effects of these scenarios were analysed using a spreadsheet model. Based on the Taoyuan County case in Taiwan, the mitigation costs of carbon emissions for rice straw and Pennisetum are 77.0 $/Mg CO(2) and 63.8 $/Mg CO(2), respectively. Results indicate that transporting feedstock from its source to the pretreatment and co-firing stations contributes the most to logistical costs for both straw and Pennisetum, regardless of whether torrefaction was adopted. Nonetheless, torrefaction requires more demonstrated cases at various scales to obtain the technical and economic data required for further analysis.

  13. Determination of the manufacturing cost by UEP method: a case study in the cold storage sausage making industry

    Directory of Open Access Journals (Sweden)

    Rodney Wernke

    2015-03-01

    Full Text Available This article aimed to answer the following research question: how to show the manager of a company that produces sausages’ the positive impacts of knowing the unit cost of processing? The objective was to verify the possibility of applying the UEP method to determine the cost of processing the products manufactured by a company of this type. A descriptive methodology was used in a case study format, with a qualitative approach. A literature review was initially conducted regarding the UEP method, approaching aspects such as history, concepts, guiding principles, steps to be taken for implementation, benefits and associated limitations. Then the main characteristics of the case study conducted through a brief description of the focused company and the steps followed to implement such a method of costing were presented. Subsequently, the informational benefits highlighted by the study and the limitations of methodology were listed . It was concluded that the method is applicable in the context of this company.

  14. The efficacy of innovative technology in improving the performance of low cost housing in South Africa: A case study

    CSIR Research Space (South Africa)

    Van Wyk, Llewellyn

    2017-08-01

    Full Text Available objective measures such as environmental monitoring, space measurement and cost analysis (Preiser et al 1988: Aitken 1998). POE proponents note that a POE usually includes a mix of quantitative and qualitative techniques. More recently, PoEs tend... Water Heater (SWH) of 100 litre capacity was installed at each house. Optimum orientation could be achieved by fitting an adjustable bracket to the ridge of the roof. The heated water is piped to the kitchen sink and the shower. The hand wash basin...

  15. Cost optimal and nearly zero-energy buildings (nZEB) definitions, calculation principles and case studies

    CERN Document Server

    Kurnitski, Jarek

    2013-01-01

    This book introduces technical definitions, system boundaries, energy calculation methods and input data for setting primary energy based minimum/cost optimal and nZEB requirements in national energy frames. Offers five case studies of nZEB office buildings.

  16. Spin mixing in Cs ultralong-range Rydberg molecules: a case study

    CERN Document Server

    Markson, Samuel; Schmidt, Richard; Shaffer, James P; Sadeghpour, H R

    2016-01-01

    We calculate vibrational spectra of ultralong-range Cs(32p) Rydberg molecules which form in an ultracold gas of Cs atoms. We account for the partial-wave scattering of the Rydberg electrons from the ground Cs perturber atoms by including the full set of spin-resolved ${}^{1,3}S_J$ and ${}^{1,3}P_J$ scattering phase shifts, and allow for the mixing of singlet (S=0) and triplet (S=1) spin states through Rydberg electron spin-orbit and ground electron hyperfine interactions. Excellent agreement with observed data in Sa{\\ss}mannshausen et al. [Phys. Rev. Lett. 113, 133201(2015)] in line positions and profiles is obtained. We also determine the spin-dependent permanent electric dipole moments for these molecules. This is the first such calculation of ultralong-range Rydberg molecules in which all of the relativistic contributions are accounted for.

  17. ANALYSIS OF MARKETING MIX ON COSMETICS PRODUCTS CASE STUDY: AVON COMPANY

    Directory of Open Access Journals (Sweden)

    ALEXANDRA PALADE

    2011-01-01

    Full Text Available This paper contains an analysis of the marketing mix followed by a Swot analysis of company Avon. It continues with a market research conducted among women in Brasov highlighting the attitudes, opinions and behaviour of women in Brasov on the acquisition and use of cosmetics product. The present paper analyzes the cosmetics market, the company Avon position in Brasov’s market, identifying the company’s main competitors, population segmentation. After analyzing data from market research shows that most women acquires cosmetic products from Avon company, the representatives role being extremely important. Most women buy products through the catalogue, 77% of them using the products every day, often buying the personal care products.

  18. Waste Management Facilities Cost Information report for Greater-Than-Class C and DOE equivalent special case waste

    Energy Technology Data Exchange (ETDEWEB)

    Feizollahi, F.; Shropshire, D.

    1993-07-01

    This Waste Management Facility Cost Information (WMFCI) report for Greater-Than-Class C low-level waste (GTCC LLW) and DOE equivalent special case waste contains preconceptual designs and planning level life-cycle cost (PLCC) estimates for treatment, storage, and disposal facilities needed for management of GTCC LLW and DOE equivalent waste. The report contains information on 16 facilities (referred to as cost modules). These facilities are treatment facility front-end and back-end support functions (administration support, and receiving, preparation, and shipping cost modules); seven treatment concepts (incineration, metal melting, shredding/compaction, solidification, vitrification, metal sizing and decontamination, and wet/air oxidation cost modules); two storage concepts (enclosed vault and silo); disposal facility front-end functions (disposal receiving and inspection cost module); and four disposal concepts (shallow-land, engineered shallow-land, intermediate depth, and deep geological cost modules). Data in this report allow the user to develop PLCC estimates for various waste management options. A procedure to guide the U.S. Department of Energy (DOE) and its contractor personnel in the use of estimating data is also included in this report.

  19. Profit and Cost Efficiency Analysis in Banking Sector: A Case of Stochastic Frontier Approach for Vietnam

    Directory of Open Access Journals (Sweden)

    Le Thi Thanh Ngan

    2014-10-01

    Full Text Available By using stochastic frontier analysis (SFA approach to measure the cost and profit efficiency for data of 45 Vietnam commercial banks over the years from 2007 to 2012, this paper highlights risk and asset quality factors related to cost and profit inefficiency of the banks. Besides, cost inefficiency seems to be strongly related to bank concentration, mergers, and bank ownership. These results suggested mergers and acquisition can gain potential cost inefficiency and foster banks’ competition in the banking system. Based on test of variance analysis, State owned commercial banks (SCOB is more efficiency than other domestic, commercial banks (JSCB and foreign banks in terms of profit efficiency, in contrast to cost efficiency, international banks are leading in cost efficiency than other national banks.

  20. BENEFIT COST FOR BIOMASS CO-FIRING IN ELECTRICITY GENERATION: CASE OF UTAH, U.S.

    Directory of Open Access Journals (Sweden)

    Man-Keun Kim

    2015-07-01

    Full Text Available Policy making regarding biomass co-firing is difficult. The article provides a benefit-cost analysis for decision makers to facilitate policy making process to implement efficient biomass co-firing policy. The additional cost is the sum of cost of the biomass procurement and biomass transportation. Co-benefits are sales of greenhouse gas emission credits and health benefit from reducing harmful air pollutants, especially particulate matter. The benefit-cost analysis is constructed for semi-arid U.S. region, Utah, where biomass supply is limited. Results show that biomass co-firing is not economically feasible in Utah but would be feasible when co-benefits are considered. Benefit-cost ratio is critically dependent upon biomass and carbon credit prices. The procedure to build the benefit-cost ratio can be applied for any region with other scenarios suggested in this study.

  1. Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training.

    Science.gov (United States)

    Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

    2014-05-01

    While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).

  2. Impact of Transport Costs on International Trade: The Case of Spanish Ceramic Exports

    OpenAIRE

    I. Martínez-Zarzoso; L García-Menéndez; C. Suárez-Burguet

    2003-01-01

    This paper aims to investigate the determinants of maritime and overland transport costs and the role they play in deterring trade across countries. We estimate a transport cost function using data on maritime and overland transport of the ceramic sector (tiles) obtained from interviews held with Spanish logistics operators. We also study the relationship between transport costs and trade and estimate an import demand model for ceramic products. Additionally, we present a discussion on the se...

  3. APPLICATION OF ACTIVITY BASED COSTING: CASE STUDY IN A CLINICAL ANALYSIS LABORATORY

    OpenAIRE

    Struett, Mirian Aparecida Micarelli; Souza, Antônio Artur de; Raimundini, Simone Letícia

    2009-01-01

    Brazilian hospital organizations are beginners when it comes to using managing tools. Under these circumstances, cost information becomes essential to the decision making process regarding their financial and operational management. Activity based costing is an example of such tools. Few publications describe researches on the use of this costing method in hospitals. However, there are no reports in the Brazilian hospital literature showing they have ever taken advantage of the use of this co...

  4. Cost Assessment of the Field Measurement of Biodiversity: a Farm-scale Case Study

    OpenAIRE

    Targetti, Stefano; Viaggi, Davide; Cuming, David

    2010-01-01

    Attention to the effects of agriculture on biodiversity is currently increasing. Yet the measurement of biodiversity is both time-consuming and costly. Considering the limited budgets available for biodiversity conservation, it is timely to focus on the cost analysis of biodiversity indicators in order to ensure the optimization of the scarce funds available. We present the cost analysis of operational data from the fieldwork efforts undertaken in the measurement of biodiver...

  5. Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial.

    Science.gov (United States)

    Scholz, Stefan M; Andermatt, Peter; Tobler, Benno L; Spinnler, Dieter

    2016-09-01

    Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p SCM, but did increase healthcare consumption and treatment costs. It is concluded that the intensity of case management alone is not sufficient to improve rehabilitation and vocational reintegration of accident victims.

  6. Stochastic Frontier Estimation of a CES Cost Function: The Case of Higher Education in Britain.

    Science.gov (United States)

    Izadi, Hooshang; Johnes, Geraint; Oskrochi, Reza; Crouchley, Robert

    2002-01-01

    Examines the use of stochastic frontier estimation of constant elasticity of substitution (CES) cost function to measure differences in efficiency among British universities. (Contains 28 references.) (PKP)

  7. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany.

    Science.gov (United States)

    Vogl, Matthias

    2012-08-30

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the "one hospital" approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the "one hospital" model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital's cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level.

  8. VIABILITY OF SOME APPLIED COST SYSTEMS IN MANUFACTURING FIRMS: EGYPT'S CASE

    Directory of Open Access Journals (Sweden)

    Karim Mamdouh ABBAS

    2015-04-01

    Full Text Available The present study aims to analyze viability of some applied cost systems. The population of the study is some Egyptian manufacturing firms. The number of received questionnaires was 385. The results indicated that , according to the application extent indicator, the currently cost systems in Egyptian manufacturing firms may be descendingly arranged as follows: Activity Based Costing (ABC system, Target Costing (TC system , Resource Consumption Accounting (RCA system, Activity Based Management (ABM ,Other systems, Theory of Constraints (TOC and Value Chain (VC analysis.

  9. Comparing systems for costing hospital treatments. The case of stable angina pectoris.

    Science.gov (United States)

    Larsen, Jytte; Skjoldborg, Ulla Slothuus

    2004-03-01

    This paper demonstrates the basic properties in the systems most commonly considered for costing treatments in the Danish hospitals. The differences between the traditional charge system, the DRG system and the ABC system are analysed, and difficulties encountered in comparing these systems are discussed. A sample of patients diagnosed with stable angina pectoris (SAP) at Odense University Hospital was used to compare the three systems when costing an entire treatment path, costing single hospitalisations and studying the effects of length of stay. Furthermore, it is illustrated that the main idea behind each system is reflected in how the systems over- or underestimate costs. Implications when managing the hospitals, particularly reimbursement, are discussed.

  10. Cost Allocation of Multiagency Water Resource Projects: Game Theoretic Approaches and Case Study

    Science.gov (United States)

    Lejano, Raul P.; Davos, Climis A.

    1995-05-01

    Water resource projects are often jointly carried out by a number of communities and agencies. Participation in a joint project depends on how costs are allocated among the participants and how cost shares compare with the cost of independent projects. Cooperative N-person game theory offers approaches which yield cost allocations that satisfy rationality conditions favoring participation. A new solution concept, the normalized nucleolus, is discussed and applied to a water reuse project in southern California. Results obtained with the normalized nucleolus are compared with those derived with more traditional solution concepts, namely, the nucleolus and the Shapley value.

  11. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany

    Science.gov (United States)

    2012-01-01

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level. First, the paper reviews and assesses the three steps in the G-DRG resource allocation scheme at hospital level: (1) the groundwork; (2) cost-center accounting; and (3) patient-level costing. Second, the paper reviews and assesses the three steps in G-DRG national tariff calculation: (1) plausibility checks; (2) inlier calculation; and (3) the “one hospital” approach. The assessment is based on the two main goals of G-DRG introduction: improving transparency and efficiency. A further empirical assessment attests high costing quality. The G-DRG cost accounting scheme shows high system quality in resource allocation at hospital level, with limitations concerning a managerially relevant full cost approach and limitations in terms of advanced activity-based costing at patient-level. However, the scheme has serious flaws in national tariff calculation: inlier calculation is normative, and the “one hospital” model causes cost bias, adjustment and representativeness issues. The G-DRG system was designed for reimbursement calculation, but developed to a standard with strategic management implications, generalized by the idea of adapting a hospital’s cost structures to DRG revenues. This combination causes problems in actual hospital financing, although resource allocation is advanced at hospital level. PMID:22935314

  12. Life cycle costing of waste management systems: Overview, calculation principles and case studies

    DEFF Research Database (Denmark)

    Martinez Sanchez, Veronica; Kromann, Mikkel A.; Astrup, Thomas Fruergaard

    2015-01-01

    This paper provides a detailed and comprehensive cost model for the economic assessment of solid waste management systems. The model was based on the principles of Life Cycle Costing (LCC) and followed a bottom-up calculation approach providing detailed cost items for all key technologies within...... regarding the cost assessment of waste management, namely system boundary equivalency, accounting for temporally distributed emissions and impacts, inclusions of transfers, the internalisation of environmental impacts and the coverage of shadow prices, and there was also significant confusion regarding...

  13. Modulation of aerosol radiative forcing due to mixing state in clear and cloudy-sky: A case study from Delhi National Capital Region, India

    Science.gov (United States)

    Srivastava, Parul; Dey, Sagnik; Srivastava, Atul K.; Singh, Sachchidanand; Tiwari, Suresh; Agarwal, Poornima

    2016-04-01

    Aerosol properties change with the change in mixing state of aerosols and therefore it is a source of uncertainty in estimated aerosol radiative forcing (ARF) from observations or by models assuming a specific mixing state. The problem is important in the Indo-Gangetic Basin, Northern India, where various aerosol types mix and show strong seasonal variations. Quantifying the modulation of ARF by mixing state is hindered by lack of knowledge about proper aerosol composition. Hence, first a detailed chemical composition analysis of aerosols for Delhi National capital region (NCR) is carried out. Aerosol composition is arranged quantitatively into five major aerosol types - accumulation dust, coarse dust, water soluble (WS), water insoluble (WINS), and black carbon (BC) (directly measured by Athelometer). Eight different mixing cases - external mixing, internal mixing, and six combinations of core- shell mixing (BC over dust, WS over dust, WS over BC, BC over WS, WS over WINS, and BC over WINS; each of the combinations externally mixed with other species) have been considered. The spectral aerosol optical properties - extinction coefficient, single scattering albedo (SSA) and asymmetry parameter (g) for each of the mixing cases are calculated and finally 'clear-sky' and 'cloudy-sky' ARF at the top-of-the-atmosphere (TOA) and surface are estimated using a radiative transfer model. Comparison of surface-reaching flux for each of the cases with MERRA downward shortwave surface flux reveals the most likely mixing state. 'BC-WINS+WS+Dust' show least deviation relative to MERRA during the pre-monsoon (MAMJ) and monsoon (JAS) seasons and hence is the most probable mixing states. During the winter season (DJF), 'BC-Dust+WS+WINS' case shows the closest match with MERRA, while external mixing is the most probable mixing state in the post-monsoon season (ON). Lowest values for both TOA and surface 'clear-sky' ARF is observed for 'BC-WINS+WS+ Dust' mixing case. TOA ARF is 0.28±2

  14. Estimating the cost-effectiveness of detecting cases of chronic hepatitis C infection on reception into prison

    Directory of Open Access Journals (Sweden)

    Edmunds W John

    2006-06-01

    Full Text Available Abstract Background In England and Wales where less than 1% of the population are Injecting drug users (IDUs, 97% of HCV reports are attributed to injecting drug use. As over 60% of the IDU population will have been imprisoned by the age of 30 years, prison may provide a good location in which to offer HCV screening and treatment. The aim of this work is to examine the cost effectiveness of a number of alternative HCV case-finding strategies on prison reception Methods A decision analysis model embedded in a model of the flow of IDUs through prison was used to estimate the cost effectiveness of a number of alternative case-finding strategies. The model estimates the average cost of identifying a new case of HCV from the perspective of the health care provider and how these estimates may evolve over time. Results The results suggest that administering verbal screening for a past positive HCV test and for ever having engaged in illicit drug use prior to the administering of ELISA and PCR tests can have a significant impact on the cost effectiveness of HCV case-finding strategies on prison reception; the discounted cost in 2017 being £2,102 per new HCV case detected compared to £3,107 when no verbal screening is employed. Conclusion The work here demonstrates the importance of targeting those individuals that have ever engaged in illicit drug use for HCV testing in prisons, these individuals can then be targeted for future intervention measures such as treatment or monitored to prevent future transmission.

  15. A mixed methods approach to assess animal vaccination programmes: The case of rabies control in Bamako, Mali.

    Science.gov (United States)

    Mosimann, Laura; Traoré, Abdallah; Mauti, Stephanie; Léchenne, Monique; Obrist, Brigit; Véron, René; Hattendorf, Jan; Zinsstag, Jakob

    2017-01-01

    effectiveness model with its determinants. In addition, qualitative data provide an explanatory framework for deeper insight, validation and interpretation of results which should improve the intervention design while involving all stakeholders and increasing community participation. This work contributes vital information for the optimization and scale-up of future vaccination campaigns in Bamako, Mali. The proposed mixed method, although incompletely applied in this case study, should be applicable to similar rabies interventions targeting elimination in other settings. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Cost-Benefit Analysis of Green Infrastructures on Community Stormwater Reduction and Utilization: A Case of Beijing, China

    Science.gov (United States)

    Liu, Wen; Chen, Weiping; Feng, Qi; Peng, Chi; Kang, Peng

    2016-12-01

    Cost-benefit analysis is demanded for guiding the plan, design and construction of green infrastructure practices in rapidly urbanized regions. We developed a framework to calculate the costs and benefits of different green infrastructures on stormwater reduction and utilization. A typical community of 54,783 m2 in Beijing was selected for case study. For the four designed green infrastructure scenarios (green space depression, porous brick pavement, storage pond, and their combination), the average annual costs of green infrastructure facilities are ranged from 40.54 to 110.31 thousand yuan, and the average of the cost per m3 stormwater reduction and utilization is 4.61 yuan. The total average annual benefits of stormwater reduction and utilization by green infrastructures of the community are ranged from 63.24 to 250.15 thousand yuan, and the benefit per m3 stormwater reduction and utilization is ranged from 5.78 to 11.14 yuan. The average ratio of average annual benefit to cost of four green infrastructure facilities is 1.91. The integrated facilities had the highest economic feasibility with a benefit to cost ratio of 2.27, and followed by the storage pond construction with a benefit to cost ratio of 2.14. The results suggested that while the stormwater reduction and utilization by green infrastructures had higher construction and maintenance costs, their comprehensive benefits including source water replacements benefits, environmental benefits and avoided cost benefits are potentially interesting. The green infrastructure practices should be promoted for sustainable management of urban stormwater.

  17. Analysis of the Effects of Compositional and Configurational Assumptions on Product Costs for the Thermochemical Conversion of Lignocellulosic Biomass to Mixed Alcohols – FY 2007 Progress Report

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Yunhua; Gerber, Mark A.; Jones, Susanne B.; Stevens, Don J.

    2009-02-01

    The purpose of this study was to examine alternative biomass-to-ethanol conversion process assumptions and configuration options to determine their relative effects on overall process economics. A process-flow-sheet computer model was used to determine the heat and material balance for each configuration that was studied. The heat and material balance was then fed to a costing spreadsheet to determine the impact on the ethanol selling price. By examining a number of operational and configuration alternatives and comparing the results to the base flow sheet, alternatives having the greatest impact the performance and cost of the overall system were identified and used to make decisions on research priorities. This report, which was originally published in December 2008, has been revised primarily to correct information presented in Appendix B -- Base Case Flow Sheets and Model Results. The corrections to Appendix B include replacement of several pages in Table B.1 that duplicated previous pages of the table. Other changes were made in Appendix B to correct inconsistencies between stream labels presented in the tables and the stream labels in the figures.

  18. The cerebral cost of breathing: an FMRI case-study in congenital central hypoventilation syndrome.

    Directory of Open Access Journals (Sweden)

    Mike Sharman

    Full Text Available Certain motor activities--like walking or breathing--present the interesting property of proceeding either automatically or under voluntary control. In the case of breathing, brainstem structures located in the medulla are in charge of the automatic mode, whereas cortico-subcortical brain networks--including various frontal lobe areas--subtend the voluntary mode. We speculated that the involvement of cortical activity during voluntary breathing could impact both on the "resting state" pattern of cortical-subcortical connectivity, and on the recruitment of executive functions mediated by the frontal lobe. In order to test this prediction we explored a patient suffering from central congenital hypoventilation syndrome (CCHS, a very rare developmental condition secondary to brainstem dysfunction. Typically, CCHS patients demonstrate efficient cortically-controlled breathing while awake, but require mechanically-assisted ventilation during sleep to overcome the inability of brainstem structures to mediate automatic breathing. We used simultaneous EEG-fMRI recordings to compare patterns of brain activity between these two types of ventilation during wakefulness. As compared with spontaneous breathing (SB, mechanical ventilation (MV restored the default mode network (DMN associated with self-consciousness, mind-wandering, creativity and introspection in healthy subjects. SB on the other hand resulted in a specific increase of functional connectivity between brainstem and frontal lobe. Behaviorally, the patient was more efficient in cognitive tasks requiring executive control during MV than during SB, in agreement with her subjective reports in everyday life. Taken together our results provide insight into the cognitive and neural costs of spontaneous breathing in one CCHS patient, and suggest that MV during waking periods may free up frontal lobe resources, and make them available for cognitive recruitment. More generally, this study reveals how the

  19. SUSTAINABILITY COST ACCOUNTING - PART 2: A CASE STUDY IN THE SOUTH AFRICAN PROCESS INDUSTRY

    Directory of Open Access Journals (Sweden)

    A.C. Brent

    2012-01-01

    Full Text Available

    ENGLISH ABSTRACT: A Sustainability Cost Accounting (SCA procedure has been introduced that expresses the impacts on sustainable development associated with a developed technology, by means of a common financial denominator. This paper uses a case study to demonstrate and assess the SCA procedure, which considers the construction and operation of a hypothetical Gas-to-Liquid (GTL fuelmanufacturing facility at a specific location in South Africa. The SCA indicators show that the negative environmental impacts associated with the GTL technology outweigh the internal economic benefits for the company. However, a net positive social benefit is associated with the technology, which decision-makers should consider with respect of the overall sustainability of the technology. Certain limitations of the SCA procedure are highlighted, and recommendations are made to develop such a methodology further.

    AFRIKAANSE OPSOMMING: ’n Volhoubaarheid Koste-Rekeningkunde prosedure (VKR word voorgestel waarvolgens die impakte van ’n ontwikkelde tegnologie op volhoubaarheid in ’n gemeenskaplike finansiële waarde aangegee kan word. ’n Gevallestudie word hier gebruik om die VKR-prosedure te demonstreer. Die gevallestudie beskryf die konstruksie en bedryf van ’n hipotetiese Gas-tot-Vloeistof brandstofvervaardigingsfasiliteit (GTV in ‘n spesifieke area van Suid-Afrika. Die VKR-indikators dui aan dat die negatiewe omgewingsimpakte van die GTV tegnologie tot ‘n geringe mate groter is as die interne ekonomiese voordele vir die maatskappy. Die tegnologie het wel oorwegende positiewe sosiale voordele wat besluitnemers in ag moet neem wanneer die globale volhoubaarheid van die tegnologie ge-assesseer word. Sekere beperkinge van die VKR-prosedure word uitgelig en voorstelle word gemaak om dié tipe metodologie verder te ontwikkel.

  20. A Case of Mixed Infections in a Patient Presenting with Acute Febrile Illness in the Tropics

    Directory of Open Access Journals (Sweden)

    L. S. Yong

    2013-01-01

    Full Text Available Concurrent infections with more than one etiological agent can result in an illness with overlapping symptoms, resulting in a situation where the diagnosis and management of such a patient could be challenging. We report a case of vivax malaria in a patient who was also serologically positive for leptospirosis and dengue.

  1. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Science.gov (United States)

    Vered, Oded; Simon-Tuval, Tzahit; Yagupsky, Pablo; Malul, Miki; Cicurel, Assi; Davidovitch, Nadav

    2015-01-01

    Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU). Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS) enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470). Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410). HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391). Before diagnosis (baseline), the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05), however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001). Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001). Additional elevated costs were 3.6 times higher laboratory tests (P<0.001), 2.8 times higher emergency room visits (P<0.001), 1.8 times higher medication (P<0.001) and 1.3 times higher diagnostic procedures (P<0.001). We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  2. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Directory of Open Access Journals (Sweden)

    Oded Vered

    Full Text Available Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU. Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470. Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410. HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391. Before diagnosis (baseline, the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05, however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001. Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001. Additional elevated costs were 3.6 times higher laboratory tests (P<0.001, 2.8 times higher emergency room visits (P<0.001, 1.8 times higher medication (P<0.001 and 1.3 times higher diagnostic procedures (P<0.001. We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  3. Building Energy and Cost Performance: An Analysis of Thirty Melbourne Case Studies

    Directory of Open Access Journals (Sweden)

    Yu Lay Langston

    2012-11-01

    Full Text Available This study investigates the energy and cost performance of thirty recent buildings in Melbourne, Australia. Commonly, building design decisions are based on issues pertaining to construction cost, and consideration of energy performance is made only within the context of the initial project budget. Even where energy is elevated to more importance, operating energy is seen as the focus and embodied energy is nearly always ignored. For the first time, a large sample of buildings has been assembled and analyzed to improve the understanding of both energy and cost performance over their full life cycle, which formed the basis of a wider doctoral study into the inherent relationship between energy and cost. The aim of this paper is to report on typical values for embodied energy, operating energy, capital cost and operating cost per square metre for a range of building functional types investigated in this research. The conclusion is that energy and cost have quite different profiles across projects, and yet the mean GJ/m2 or cost/m2 have relatively low coefficients of variation and therefore may be useful as benchmarks of typical building performance.  

  4. Estimating the Effects of Teaching on the Costs of Inpatient Care: The Case of Radiology Treatments.

    Science.gov (United States)

    Massell, Adele P.; Hosek, James R.

    The report investigates production and the cost effects of teaching within hospital departments. Models of primary production show that the cost effects of teaching are determined by the salaries paid to students (including residents, interns, medical students, and technical trainees) and physicians, by the levels of student inputs used in…

  5. On dealing with the pollution costs in agriculture: A case study of paddy fields

    Energy Technology Data Exchange (ETDEWEB)

    Yaqubi, Morteza, E-mail: yaqubi@pgs.usb.ac.ir [Faculty of Management and Economics, Department of Agricultural Economics, University of Sistan and Baluchestan Zahedan (Iran, Islamic Republic of); Shahraki, Javad, E-mail: j.shahraki@eco.usb.ac.ir [Faculty of Management and Economics, Department of Agricultural Economics, University of Sistan and Baluchestan Zahedan (Iran, Islamic Republic of); Sabouhi Sabouni, Mahmood, E-mail: sabouhi@ferdowsi.um.ac.ir [Department of Agricultural Economics, Ferdowsi University of Mashhad, Azadi Square, Mashhad (Iran, Islamic Republic of)

    2016-06-15

    The main purpose of this study is to evaluate marginal abatement cost of the main agricultural pollutants. In this sense, we construct three indices including Net Global Warming Potential (NGWP) and Nitrogen Surplus (NS), simulated by a biogeochemistry model, and also an Environmental Impact Quotient (EQI) for paddy fields. Then, using a Data Envelopment Analysis (DEA) model, we evaluate environmental inefficiencies and shadow values of these indices. The results show that there is still room for improvement at no extra cost just through a better input management. Besides, enormous potential for pollution reduction in the region is feasible. Moreover, in paddy cultivation, marginal abatement cost of pesticides and herbicides are much bigger than nitrogen surplus and greenhouse gasses. In addition, in the status quo, the mitigation costs are irrelevant to production decisions. Finally, to deal with the private pollution costs, market-based instruments are proved to be better than command-and-control regulation. - Highlights: • To evaluate agricultural pollution costs, a combination of two DNDC and DEA models was introduced. • The shadow values of three main agricultural pollutants in paddy fields were evaluated. • In the study area, a high potential for pollution reduction is feasible. • The pollution cost of pesticides are much bigger than nitrogen surplus and greenhouse gases. • From the farmers' viewpoint, a positive shadow value of undesirable outputs also is feasible. • To deal with the pollution costs, market-based instruments are preferred to command-and-control regulation.

  6. Urban forest restoration cost modeling: a Seattle natural areas case study

    Science.gov (United States)

    Jean M. Daniels; Weston Brinkley; Michael D. Paruszkiewicz

    2016-01-01

    Cities have become more committed to ecological restoration and management activities in urban natural areas. Data about costs are needed for better planning and reporting. The objective of this study is to estimate the costs for restoration activities in urban parks and green space in Seattle, Washington. Stewardship activity data were generated from a new database...

  7. Comparing the social costs of biofuels and fossil fuels: A case study of Vietnam

    NARCIS (Netherlands)

    Thanh, le L.; Ierland, van E.C.; Zhu, X.; Wesseler, J.H.H.; Ngo, G.

    2013-01-01

    Biofuel substitution for fossil fuels has been recommended in the literature and promoted in many countries; however, there are concerns about its economic viability. In this paper we focus on the cost-effectiveness of fuels, i.e., we compare the social costs of biofuels and fossil fuels for a

  8. The case for renewable energy: levelised electricity costs under alternative abatement scenarios

    Energy Technology Data Exchange (ETDEWEB)

    Windram, C.; Dix, S. [E3 International Pty Ltd., Indooroopilly, Qld. (Australia). Environment, Economics & Ethics

    2001-07-01

    This paper compares the relative cost performance of a number of conventional, clean coal and sustainable energy technologies under three alternative carbon abatement scenarios, each characterized by a different cost of abatement under an Australian domestic emissions trading scheme. 4 refs., 1 fig., 1 tab.

  9. Comparing the social costs of biofuels and fossil fuels: A case study of Vietnam

    NARCIS (Netherlands)

    Thanh, le L.; Ierland, van E.C.; Zhu, X.; Wesseler, J.H.H.; Ngo, G.

    2013-01-01

    Biofuel substitution for fossil fuels has been recommended in the literature and promoted in many countries; however, there are concerns about its economic viability. In this paper we focus on the cost-effectiveness of fuels, i.e., we compare the social costs of biofuels and fossil fuels for a funct

  10. Cost benefit analysis of a transport improvement in the case of search unemployment

    DEFF Research Database (Denmark)

    Pilegaard, Ninette; Fosgerau, Mogens

    2008-01-01

    We examine the implications of search unemployment for the evaluation of a transport investment in a conventional cost benefit analysis (CBA) assuming perfect competition. Lower transport costs induce search over a larger area and longer commuting distances. The expected duration of vacancies...

  11. Measuring the costs of biosecurity on poultry farms: a case study in broiler production in Finland

    Science.gov (United States)

    2012-01-01

    Background Farm-level biosecurity provides the foundation for biosecurity along the entire production chain. Many risk management practices are constantly in place, regardless of whether there is a disease outbreak or not. Nonetheless, the farm-level costs of preventive biosecurity have rarely been assessed. We examined the costs incurred by preventive biosecurity for Finnish poultry farms. Methods We used a semi-structured phone interview and obtained results from 17 broiler producers and from 5 hatching egg producers, corresponding to about 10% of all producers in Finland. Results Our results indicate that the average cost of biosecurity is some 3.55 eurocent per bird for broiler producers (0.10 eurocent per bird per rearing day) and 75.7 eurocent per bird for hatching egg producers (0.27 eurocent per bird per rearing day). For a batch of 75,000 broilers, the total cost would be €2,700. The total costs per bird are dependent on the annual number of birds: the higher the number of birds, the lower the cost per bird. This impact is primarily due to decreasing labour costs rather than direct monetary costs. Larger farms seem to utilise less labour per bird for biosecurity actions. There are also differences relating to the processor with which the producer is associated, as well as to the gender of the producer, with female producers investing more in biosecurity. Bird density was found to be positively related to the labour costs of biosecurity. This suggests that when the bird density is higher, greater labour resources need to be invested in their health and welfare and hence disease prevention. The use of coccidiostats as a preventive measure to control coccidiosis was found to have the largest cost variance between the producers, contributing to the direct costs. Conclusions The redesign of cost-sharing in animal diseases is currently ongoing in the European Union. Before we can assert how the risk should be shared or resort to the 'polluter pays' principle

  12. On dealing with the pollution costs in agriculture: A case study of paddy fields.

    Science.gov (United States)

    Yaqubi, Morteza; Shahraki, Javad; Sabouhi Sabouni, Mahmood

    2016-06-15

    The main purpose of this study is to evaluate marginal abatement cost of the main agricultural pollutants. In this sense, we construct three indices including Net Global Warming Potential (NGWP) and Nitrogen Surplus (NS), simulated by a biogeochemistry model, and also an Environmental Impact Quotient (EQI) for paddy fields. Then, using a Data Envelopment Analysis (DEA) model, we evaluate environmental inefficiencies and shadow values of these indices. The results show that there is still room for improvement at no extra cost just through a better input management. Besides, enormous potential for pollution reduction in the region is feasible. Moreover, in paddy cultivation, marginal abatement cost of pesticides and herbicides are much bigger than nitrogen surplus and greenhouse gasses. In addition, in the status quo, the mitigation costs are irrelevant to production decisions. Finally, to deal with the private pollution costs, market-based instruments are proved to be better than command-and-control regulation.

  13. Outreach at Washington State University: a case study in costs and attendance

    Science.gov (United States)

    Bernhardt, Elizabeth A.; Bollen, Viktor; Bersano, Thomas M.; Mossman, Sean M.

    2016-09-01

    Making effective and efficient use of outreach resources can be difficult for student groups in smaller rural communities. Washington State University's OSA/SPIE student chapter desires well attended yet cost-effective ways to educate and inform the public. We designed outreach activities focused on three different funding levels: low upfront cost, moderate continuing costs, and high upfront cost with low continuing costs. By featuring our activities at well attended events, such as a pre-football game event, or by advertising a headlining activity, such as a laser maze, we take advantage of large crowds to create a relaxed learning atmosphere. Moreover, participants enjoy casual learning while waiting for a main event. Choosing a particular funding level and associating with well-attended events makes outreach easier. While there are still many challenges to outreach, such as motivating volunteers or designing outreach programs, we hope overcoming two large obstacles will lead to future outreach success.

  14. A mixed toxidrome presenting with bilateral ptosis with normal pupils: The first case in the literature

    Directory of Open Access Journals (Sweden)

    Sanket Mahajan

    2016-01-01

    Full Text Available Snakebite is an environmental hazard associated with a significant morbidity and mortality. Two main types of toxicity occur due to snakebite, namely vasculotoxicity and neurotoxicity. Neurotoxic snakebites present mainly with bilateral ptosis with dilated pupils and/or difficulty in breathing. Jatropha curcas belongs to the family Euphorbiaceae and is commonly referred to as " Ratanjyot" in Gujarati. It has got many medicinal uses such as anticancerous properties and bio-oil. There are very few cases of its toxicity in adults. Toxicity from it causes meiosis, vomiting, diarrhea, etc., We will hereby discuss one such patient who consumed J. curcas seeds intentionally, became drowsy and accidentally got bit by a snake, and then, the patient started having bilateral ptosis, but with normal-sized pupils. There is no case reported yet in the literature mentioning the combined toxicity of snakebite and J. curcas, so we thought to publish this first case report of its kind in the world, thus discussing its diagnosis, symptoms, and treatment modalities.

  15. A Feasibility Study of Implementing Target Costing System in Porcelain Sanitary-ware Industry (Case Study: Chini Kord Company, Kermanshah

    Directory of Open Access Journals (Sweden)

    B. Saeidipour

    2013-12-01

    Full Text Available Due to importance of costs, profitability, and survival in the competitive market, producing company managers work around the clock to reduce the prices and increase the profits. Target costing is a strategic approach to cost management aiming at promoting competitive potentials of the companies. This research is a grounded-case study studying feasibility of running target costing system in Chini Kord Company, Kermanshah branch which produces hygienic porcelain ware. Through stratified random sampling and Morgan Table, out of an 800 statistical population, a 260 sample size was chosen. To validate the questionnaire, Likret Scale and to analyze the data, inferential and descriptive statistical tools such as mean, variance, standard deviation, T-test, one-way ANOVA, single sample T, and SPSS software were used. The results indicated that running target costing in market-driven level, product-level, component level and net profit margin level was feasible, and all the questions were valid. Moreover, it was proved there is no significant difference between managers, experts, and workers’ opinions on target costing feasibility and all consented on its implementation.

  16. Visual representation of costs in the productive process: a case study on a footwear industry in Portugal

    Directory of Open Access Journals (Sweden)

    Levi da Silva Guimarães

    2015-12-01

    Full Text Available Over the last decades, conventional production systems have gone through changes in the face of intensified competition among companies. The occurrence of these changes has boosted the development of decision-making assistance tools for the production systems. However, most of these instruments do not allow the visualization of the costs involved throughout industrial operations. This study comprises the integration of the "Waste Identification Diagrams" (WID, current tool for visualization and analysis of production processes, along with "Time-Driven Activity-Based Costing" (TDABC, strategic management cost tool, seeking to create a model that visually demonstrates waste and relate its occurrence to operating costs. For that, the research adopted a descriptive-exploratory approach, based on a case study carried out in a footwear industry. The analysis showed that the integration of tools allowed for the representation of costs based on the time equations from the TDABC, associated with the visualization of the production process by the WID. The study concludes that the WID can be integrated to the TDABC tool, creating a management model for making decisions based on the operating costs of the production process.

  17. A case report of bilateral Brodie bite in early mixed dentition using bonded constriction quad-helix appliance.

    Science.gov (United States)

    Nojima, Kunihiko; Takaku, Sakiko; Murase, Chiaki; Nishii, Yasushi; Sueishi, Kenji

    2011-01-01

    Brodie bite is a comparatively rare type of malocclusion found in primary and mixed dentition. It not only adversely affects chewing and muscle functions, but also impairs normal growth and development of the mandible. This report describes the therapeutic results of a patient with bilateral Brodie bite in early mixed dentition after using a bonded constriction quad-helix appliance. The patient, a boy aged 9 years and 2 months, first visited our hospital after occlusal abnormality in the molar region was detected at a local dental clinic. Case analysis resulted in a diagnosis of bilateral Brodie bite with slight mandibular retrognathism. Treatment objectives were to reduce the arch width of the maxillary dentition and expand the mandibular arch in order to establish and stabilize molar occlusion and to achieve a Class I molar relation and appropriate overbite and overjet. Treatment comprised covering the occlusal surface of the maxillary molars with resin and attaching a bonded constriction quad-helix appliance joined with a 0.040-inch quad-helix wire. A bi-helix appliance was also fixed to the mandibular dentition. Brodie bite visibly improved after 5 months. Cervical headgear was then fitted and the patient observed until eruption of the permanent dentition was complete. Class I molar relation was achieved after 2 years and 6 months, although spacing remained in the maxillary and mandibular dentitions. Treatment of bilateral Brodie bite in mixed dentition by means of a bonded constriction quad-helix appliance attached to the maxillary dentition enabled effective bite opening and reduction in the width of maxillary arch independent of the patient's cooperation, providing good therapeutic outcome in a short time period.

  18. The cost of Child Health Days: a case study of Ethiopia's Enhanced Outreach Strategy (EOS).

    Science.gov (United States)

    Fiedler, John L; Chuko, Tesfaye

    2008-07-01

    Child Health Days (CHDs) are twice-annual campaign-style events designed to increase the coverage of vitamin A and one or more other child health services. Although more than two dozen countries have had a CHD, little has been published about them. This paper presents an activity-based costing study of Ethiopia's version of CHDs, the Enhanced Outreach Strategy (EOS). The December 2006 round reached more than 10 million beneficiaries at an average cost per beneficiary of US$0.56. When measles is added, the cost of the package doubles. Given the way the distribution day delivery system and the service package are structured, there are economies of scope. Because most of the costs are determined by the number of delivery sites and are independent of the number of beneficiaries, other things equal, increasing the beneficiaries would reduce the average cost per beneficiary. Taking into account only the mortality impact of vitamin A, EOS saved 20,200 lives and averted 230,000 DALYs of children 6-59 months. The average cost per life saved was US$228 and the cost per DALY averted was equivalent to 6% of per capita GDP (US$9), making the EOS cost-effective, according to WHO criteria. While CHDs are generally construed as a temporary strategy for improving coverage of supply-constrained systems, inadequate attention has been paid to demand-side considerations that suggest CHDs have an important role to play in changing care-seeking behaviour, in increasing community organization and participation, and in promoting district autonomy and capacity. Recognition of these effects suggests the need for decisions about where and when to introduce, and when to end, a CHD to take into account more than 'just' health sector considerations: they are more broadly about community development. UNICEF played a key role in initiating the EOS and finances 68% of costs, raising concern about the programme's long-term sustainability.

  19. Cost effectiveness of tobacco control policies in Vietnam: the case of population-level interventions.

    Science.gov (United States)

    Higashi, Hideki; Truong, Khoa D; Barendregt, Jan J; Nguyen, Phuong K; Vuong, Mai L; Nguyen, Thuy T; Hoang, Phuong T; Wallace, Angela L; Tran, Tien V; Le, Cuong Q; Doran, Christopher M

    2011-05-01

    Tobacco smoking is one of the leading public health problems in the world. It is also possible to prevent and/or reduce the harm from tobacco use through the use of cost-effective tobacco control measures. However, most of this evidence comes from developed countries and little research has been conducted on this issue in developing countries. The objective of this study was to analyse the cost effectiveness of four population-level tobacco control interventions in Vietnam. Four tobacco control interventions were evaluated: excise tax increase; graphic warning labels on cigarette packs; mass media campaigns; and smoking bans (in public or in work places). A multi-state life table model was constructed in Microsoft® Excel to examine the cost effectiveness of the tobacco control intervention options. A government perspective was adopted, with costing conducted using a bottom-up approach. Health improvement was considered in terms of disability-adjusted life-years (DALYs) averted. All assumptions were subject to sensitivity and uncertainty analysis. All the interventions fell within the definition of being very cost effective according to the threshold level suggested by the WHO (i.e. GDP per capita). Graphic warning labels on cigarette packs was the most cost-effective option, followed by excise tax increases, mass media campaigns, public smoking bans and work place smoking bans. If the cost offset was included in the analysis, all interventions would provide cost savings to the government health sector. All four interventions to reduce the harm from tobacco use appear to be highly cost effective and should be considered as priorities in the context of Vietnam. The government may initially consider graphic warning labels and tax increase, followed by other interventions.

  20. The Use of Mixed Effects Models for Obtaining Low-Cost Ecosystem Carbon Stock Estimates in Mangroves of the Asia-Pacific

    Science.gov (United States)

    Bukoski, Jacob J.; Broadhead, Jeremy S.; Donato, Daniel C.; Murdiyarso, Daniel; Gregoire, Timothy G.

    2017-01-01

    Mangroves provide extensive ecosystem services that support local livelihoods and international environmental goals, including coastal protection, biodiversity conservation and the sequestration of carbon (C). While voluntary C market projects seeking to preserve and enhance forest C stocks offer a potential means of generating finance for mangrove conservation, their implementation faces barriers due to the high costs of quantifying C stocks through field inventories. To streamline C quantification in mangrove conservation projects, we develop predictive models for (i) biomass-based C stocks, and (ii) soil-based C stocks for the mangroves of the Asia-Pacific. We compile datasets of mangrove biomass C (197 observations from 48 sites) and soil organic C (99 observations from 27 sites) to parameterize the predictive models, and use linear mixed effect models to model the expected C as a function of stand attributes. The most parsimonious biomass model predicts total biomass C stocks as a function of both basal area and the interaction between latitude and basal area, whereas the most parsimonious soil C model predicts soil C stocks as a function of the logarithmic transformations of both latitude and basal area. Random effects are specified by site for both models, which are found to explain a substantial proportion of variance within the estimation datasets and indicate significant heterogeneity across-sites within the region. The root mean square error (RMSE) of the biomass C model is approximated at 24.6 Mg/ha (18.4% of mean biomass C in the dataset), whereas the RMSE of the soil C model is estimated at 4.9 mg C/cm3 (14.1% of mean soil C). The results point to a need for standardization of forest metrics to facilitate meta-analyses, as well as provide important considerations for refining ecosystem C stock models in mangroves. PMID:28068361

  1. The Use of Mixed Effects Models for Obtaining Low-Cost Ecosystem Carbon Stock Estimates in Mangroves of the Asia-Pacific.

    Science.gov (United States)

    Bukoski, Jacob J; Broadhead, Jeremy S; Donato, Daniel C; Murdiyarso, Daniel; Gregoire, Timothy G

    2017-01-01

    Mangroves provide extensive ecosystem services that support local livelihoods and international environmental goals, including coastal protection, biodiversity conservation and the sequestration of carbon (C). While voluntary C market projects seeking to preserve and enhance forest C stocks offer a potential means of generating finance for mangrove conservation, their implementation faces barriers due to the high costs of quantifying C stocks through field inventories. To streamline C quantification in mangrove conservation projects, we develop predictive models for (i) biomass-based C stocks, and (ii) soil-based C stocks for the mangroves of the Asia-Pacific. We compile datasets of mangrove biomass C (197 observations from 48 sites) and soil organic C (99 observations from 27 sites) to parameterize the predictive models, and use linear mixed effect models to model the expected C as a function of stand attributes. The most parsimonious biomass model predicts total biomass C stocks as a function of both basal area and the interaction between latitude and basal area, whereas the most parsimonious soil C model predicts soil C stocks as a function of the logarithmic transformations of both latitude and basal area. Random effects are specified by site for both models, which are found to explain a substantial proportion of variance within the estimation datasets and indicate significant heterogeneity across-sites within the region. The root mean square error (RMSE) of the biomass C model is approximated at 24.6 Mg/ha (18.4% of mean biomass C in the dataset), whereas the RMSE of the soil C model is estimated at 4.9 mg C/cm3 (14.1% of mean soil C). The results point to a need for standardization of forest metrics to facilitate meta-analyses, as well as provide important considerations for refining ecosystem C stock models in mangroves.

  2. The Use of Mixed Effects Models for Obtaining Low-Cost Ecosystem Carbon Stock Estimates in Mangroves of the Asia-Pacific

    Science.gov (United States)

    Bukoski, J. J.; Broadhead, J. S.; Donato, D.; Murdiyarso, D.; Gregoire, T. G.

    2016-12-01

    Mangroves provide extensive ecosystem services that support both local livelihoods and international environmental goals, including coastal protection, water filtration, biodiversity conservation and the sequestration of carbon (C). While voluntary C market projects that seek to preserve and enhance forest C stocks offer a potential means of generating finance for mangrove conservation, their implementation faces barriers due to the high costs of quantifying C stocks through measurement, reporting and verification (MRV) activities. To streamline MRV activities in mangrove C forestry projects, we develop predictive models for (i) biomass-based C stocks, and (ii) soil-based C stocks for the mangroves of the Asia-Pacific. We use linear mixed effect models to account for spatial correlation in modeling the expected C as a function of stand attributes. The most parsimonious biomass model predicts total biomass C stocks as a function of both basal area and the interaction between latitude and basal area, whereas the most parsimonious soil C model predicts soil C stocks as a function of the logarithmic transformations of both latitude and basal area. Random effects are specified by site for both models, and are found to explain a substantial proportion of variance within the estimation datasets. The root mean square error (RMSE) of the biomass C model is approximated at 24.6 Mg/ha (18.4% of mean biomass C in the dataset), whereas the RMSE of the soil C model is estimated at 4.9 mg C/cm 3 (14.1% of mean soil C). A substantial proportion of the variation in soil C, however, is explained by the random effects and thus the use of the SOC model may be most valuable for sites in which field measurements of soil C exist.

  3. A technique for determining the optimum mix of logistics service providers of a make-to-order supply chain by formulating and solving a constrained nonlinear cost optimization problem

    Directory of Open Access Journals (Sweden)

    Mrityunjoy Roy

    2013-04-01

    Full Text Available In this paper, a technique has been developed to determine the optimum mix of logistic service providers of a make-to-order (MTO supply chain. A serial MTO supply chain with different stages/ processes has been considered. For each stage different logistic service providers with different mean processing lead times, but same lead time variances are available. A realistic assumption that for each stage, the logistic service provider who charges more for his service consumes less processing lead time and vice-versa has been made in our study. Thus for each stage, for each service provider, a combination of cost and mean processing lead time is available. Using these combinations, for each stage, a polynomial curve, expressing cost of that stage as a function of mean processing lead time is fit. Cumulating all such expressions of cost for the different stages along with incorporation of suitable constraints arising out of timely delivery, results in the formulation of a constrained nonlinear cost optimization problem. On solving the problem using mathematica, optimum processing lead time for each stage is obtained. Using these optimum processing lead times and by employing a simple technique the optimum logistic service provider mix of the supply chain along with the corresponding total cost of processing is determined. Finally to examine the effect of changes in different parameters on the optimum total processing cost of the supply chain, sensitivity analysis has been carried out graphically.

  4. Mixed Cutaneous Infection Caused by Mycobacterium szulgai and Mycobacterium intermedium in a Healthy Adult Female: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Amresh Kumar Singh

    2015-01-01

    Full Text Available Nontuberculous mycobacteria (NTMs are ubiquitous and are being increasingly reported as human opportunistic infection. Cutaneous infection caused by mixed NTM is extremely rare. We encountered the case of a 46-year-old female, who presented with multiple discharging sinuses over the lower anterior abdominal wall (over a previous appendectomy scar for the past 2 years. Microscopy and culture of the pus discharge were done to isolate and identify the etiological agent. Finally, GenoType Mycobacterium CM/AS assay proved it to be a mixed infection caused by Mycobacterium szulgai and M. intermedium. The patient was advised a combination of rifampicin 600 mg once daily, ethambutol 600 mg once daily, and clarithromycin 500 mg twice daily to be taken along with periodic follow-up based upon clinical response as well as microbiological response. We emphasize that infections by NTM must be considered in the etiology of nonhealing wounds or sinuses, especially at postsurgical sites.

  5. Costs of Reducing Greenhouse Gas Emissions: A Case Study of India’s Power Generation Sector

    OpenAIRE

    Gupta, Manish

    2006-01-01

    If India were to participate in any international effort towards mitigating CO2 emissions, the power sector which is one of the largest emitters of CO2 in the country would be required to play a major role. In this context the study estimates the marginal abatement costs, which correspond to the costs incurred by the power plants to reduce one unit of CO2 from the current level. The study uses an output distance function approach and its duality with the revenue function to derive these costs...

  6. Retroperitoneal Malignant Mesenchymoma: A Case of Mesenchymal Mixed Tumor with Osteosarcoma, Leiomyosarcoma, Liposarcoma and Fibrosarcoma

    Science.gov (United States)

    Choi, Jung Eun; Yoo, Won Jong; Chung, Myung Hee; Sung, Mi Sook; Lee, Hae Giu; Park, Il Young; Kim, Jeana

    2002-01-01

    Malignant mesenchymoma is an interesting but very rare tumor in which malignant differentiation has occurred twice or more. We report a case of retroperitoneal malignant mesenchymoma consisting of osteosarcoma, leiomyosarcoma, liposarcoma and fibrosarcoma. Abdominal CT showed a large retroperitoneal mass with two separate and distinct parts, namely an area of prominent calcification and one of clearly enhancing solid components. The mass contained histologically distinct tumorous components with no histologic admixure at the interfaces. The densely calcified nodule corresponded to osteosarcoma, and the non-calcified clearly enhancing nodules to leiomyosarcoma, liposarcoma and fibrosarcoma. PMID:12514345

  7. Ameloblastic fibro-odontoma: expansile mixed radiolucent lesion in the posterior maxilla: a case report.

    Science.gov (United States)

    Zouhary, Kenneth J; Said-Al-Naief, Nasser; Waite, Peter D

    2008-10-01

    Ameloblastic fibro-odontoma (AFO) is a benign tumor that displays properties of both ameloblastic fibroma and compound odontoma. Often, AFO presents clinically as a hamartoma or immature odontoma; however, the tumor can also present with progressive growth causing bone destruction and significant deformity, acting more like a true neoplasm. We report a case of a locally aggressive AFO in the posterior maxilla of a 7-year-old girl and discuss the clinical, radiographic, histopathologic, and conservative therapeutic approach to this locally aggressive tumor.

  8. A case of mixed bullous disease of epidermolysis bullosa acquisita and linear IgA bullous dermatosis.

    Science.gov (United States)

    Osawa, Masumi; Demitsu, Toshio; Toda, Sunao; Yokokura, Hideto; Umemoto, Naoka; Yamada, Tomoko; Yoneda, Kozo; Kakurai, Maki; Yoshida, Mariko; Hashimoto, Takashi

    2005-01-01

    A 75-year-old Japanese male visited us with bullous eruptions on the extremities. Physical examination revealed large bullae on the hands, lower legs and feet. The oral mucosa was also involved. Histology disclosed subepidermal blister with inflammatory cell infiltrates in the dermis. Direct immunofluorescence showed deposits of IgG and IgA at the cutaneous basement membrane zone. Indirect immunofluorescence on 1 M NaCl-split human skin sections demonstrated that the patient's IgG antibodies reacted with the dermal side of the split, while IgA antibodies reacted with the epidermal side. Immunoblotting showed that the patient's serum reacted with the NC1 domain of type VII collagen (290-kDa epidermolysis bullosa acquisita antigen) as well as the 120-kDa linear IgA bullous dermatosis antigen, LAD-1. Systemic prednisolone resulted in a favorable response. From the clinicopathological findings, the present case is not consistent with either epidermolysis bullosa acquisita or IgA bullous dermatosis. Therefore, we regarded the case as mixed bullous disease of epidermolysis bullosa acquisita and linear IgA bullous dermatosis. Such a case has not been previously reported.

  9. A Framework of Combining Case-Based Reasoning with a Work Breakdown Structure for Estimating the Cost of Online Course Production Projects

    Science.gov (United States)

    He, Wu

    2014-01-01

    Currently, a work breakdown structure (WBS) approach is used as the most common cost estimation approach for online course production projects. To improve the practice of cost estimation, this paper proposes a novel framework to estimate the cost for online course production projects using a case-based reasoning (CBR) technique and a WBS. A…

  10. A comparative analysis of revenue and cost-management strategies of not-for-profit and for-profit hospitals.

    Science.gov (United States)

    Shukla, R K; Pestian, J; Clement, J

    1997-01-01

    Not-for-profit (NFP) and for-profit (FP) hospitals were compared on several performance indicators including revenues, costs, productivity/efficiency, and profitability. The indicators were adjusted, where appropriate, for outpatient activity and a case-mix index for all patients. FP hospitals had higher profit margins as well as higher gross and net revenues per case-mix adjusted admission. On the other hand, NFP hospitals had lower total cost per case-mix adjusted admission even after subtracting taxes from FP hospital costs. There were no significant differences between the two groups on efficiency and productivity indicators--paid hours per case-mix adjusted admissions, occupancy levels, and case-mix adjusted ALOS. The higher profits of FP hospitals were attributed to revenue management rather than cost and efficiency management.

  11. Mixed adenoneuroendocrine carcinoma of the gastric stump following Billroth II gastrectomy: case report and review of the literature.

    Science.gov (United States)

    Cazzo, Everton; de Saito, Helena Paes de Almeida

    2016-01-01

    Gastric stump cancer after gastric resection is a well-known disease. It may be a newly developed cancer after resection due to benign disease, or recurrent or residual disease after oncological surgery. The predominant histological type is usually adenocarcinoma. This study aimed to report on a rare occurrence of a mixed adenoneuroendocrine carcinoma (MANEC) on the gastric stump. The case of an 83-year-old female who presented a locally aggressive gastric stump MANEC, 35 years after Billroth II gastrectomy to treat a peptic ulcer, is reported. The patient underwent resection and adjuvant therapy. She has been followed up for one year without signs of recurrence. MANEC is a rare type of gastrointestinal neoplasm. The classification, histopathology, clinical features, treatment issues and prognosis are discussed along with a brief review of the literature.

  12. Mixed Supply Model of Public Service Provision in “Village to Residence” Community: An Empirical Case Study in Jinan

    Directory of Open Access Journals (Sweden)

    Chunlei Huang

    2015-08-01

    Full Text Available China is experiencing rapid transition of urbanization. From the 1980s till now, the transformation of “village to residence” has become a prominent approach for numerous villages in the urban-fringe areas of China. This paper discusses the mixed supply model of public service provision, on the basis of an empirical study of two cases in Jinan City, by illustrating the transformation of urbanization and how public services in the communities are delivered. The paper also considers existing challenges in the model and accordingly provides a series of policy suggestions, including defining responsibilities of government, speeding up the joint-stock reform of collective assets and innovating the public service provision mechanism.

  13. Music therapy for early cognitive rehabilitation post-childhood TBI: an intrinsic mixed methods case study.

    Science.gov (United States)

    Bower, Janeen; Catroppa, Cathy; Grocke, Denise; Shoemark, Helen

    2014-10-01

    The primary aim of this case study was to explore the behavioural changes of a paediatric patient in post-traumatic amnesia (PTA) during a music therapy session. A secondary objective was to measure the effect of the music therapy intervention on agitation. Video data from pre, during and post-music therapy sessions were collected and analysed using video micro-analysis and the Agitated Behaviour Scale. The participant displayed four discrete categories of behaviours: Neutral, Acceptance, Recruitment and Rejection. Further analysis revealed brief but consistent and repeated periods of awareness and responsiveness to the live singing of familiar songs, which were classified as Islands of Awareness. Song offered an Environment of Potential to maximise these periods of emerging consciousness. The quantitative data analysis yielded inconclusive results in determining if music therapy was effective in reducing agitation during and immediately post the music therapy sessions. The process of micro-analysis illuminated four discrete participant behaviours not apparent in the immediate clinical setting. The results of this case suggest that the use of familiar song as a music therapy intervention may harness early patient responsiveness to foster cognitive rehabilitation in the early acute phase post-TBI.

  14. Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany

    National Research Council Canada - National Science Library

    Vogl, Matthias

    2012-01-01

    The purpose of this paper is to analyze the German diagnosis related groups (G-DRG) cost accounting scheme by assessing its resource allocation at hospital level and its tariff calculation at national level...

  15. The Inherent Building Energy-Cost Relationship: An Analysis of Thirty Melbourne Case Studies

    Directory of Open Access Journals (Sweden)

    Yu Lay Langston

    2012-11-01

    Full Text Available This study investigates the energy and cost performance of thirtyrecent buildings in Melbourne, Australia. Commonly, buildingdesign decisions are based on issues pertaining to constructioncost, and consideration of energy performance is made onlywithin the context of the initial project budget. Even where energyis elevated to more importance, operating energy is seen asthe focus and embodied energy is nearly always ignored. Forthe fi rst time, a large sample of buildings has been assembledand analysed to improve the understanding of both energy andcost performance over their full life cycle. The aim of this paperis to determine the relationship between energy and cost usingregression analysis for a range of building functional types.The conclusion is that energy and cost are strongly correlated,independent of building area, and equations are presented forfuture modelling of energy using cost as the independent variable.

  16. Issues concerning Citizenization Cost Sharing of the Population Transferred from Agriculture: A Case Study of Chongqing

    Institute of Scientific and Technical Information of China (English)

    Ying ZHANG; Xuecong JIA; Hongge YE

    2016-01-01

    The citizenization of the population transferred from agriculture is an inevitable process for Chinese social transformation,and one of the core issues in the course of new urbanization. The core problem in citizenization of the population transferred from agriculture lies in cost.Taking Chongqing as an example,this paper calculates the total citizenization cost to be 125038. 7 yuan for the population transferred from agriculture. Through field survey and research,this paper analyzes the current situation of citizenization cost sharing of the population transferred from agriculture in Chongqing,points out some problems in cost sharing such as inadequate governmental financial capacity,absence of business and lack of personal affordability,and finally brings forward the corresponding policy recommendations.

  17. External Cost Assessment of Nuclear Power Plant Accident considering Public Risk Aversion Behavior: the Korean Case

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hun; Kang, Hyun Gook [KAIST, Daejeon (Korea, Republic of)

    2016-05-15

    The conventional approach for monetary valuation of NPP accident consequence consists of calculating the expected value of various accident scenarios. However, the main criticism of the conventional approach is that there is a discrepancy between the social acceptability of the risk and the estimated expected value of NPP accident. Therefore, an integrated framework for the estimation of the external cost associated with an NPP accident considering the public risk aversion behavior was proposed in this study based on the constructed theoretical framework for estimating both the value of statistical life (VSL) and the risk aversion coefficient associated with an NPP accident to take account of the accident cost into the unit electricity generation cost of NPP. To estimate both parameters, an individual-level survey was conducted on a sample of 1,364 participants in Korea. Based on the collected survey responses, both parameters were estimated based on the proposed framework and the external cost of NPP accident was estimated based on the consequence analysis and considering the direct cost factors for NPP accident. Internalization of external costs into the comprehensive energy production cost has been considered as a potentially efficient policy instrument for a more sustainable energy supply and use. However, the internalization of externalities, such as public health damage, have raised a number of generic policy issues in a nuclear energy sector, with specific challenges resulting from the distinct characteristics of external cost estimation. Especially, the major challenge remained to address the public safety concerns regarding a nuclear accident, which can be specified as low-probability high-consequence accident, driven by the aspects of public risk aversion.

  18. Cost Efficiency and Farm Self-selection in Precision Farming: The Case of Czech Wheat Production

    OpenAIRE

    Curtiss, Jarmila; Jelinek, Ladislav

    2012-01-01

    This paper examines allocative and cost efficiency implications of adopting variable-rate fertiliser application using survey data from Czech wheat farms. Data Envelopment Analysis delivered higher efficiency scores for precision farming (PF) adopters. Correcting for selection bias using a one-step endogenous switching regression reveals that farms displaying a lower cost efficiency score are less likely to adopt PF technology. Nonadopters switching to PF technology would likely be affected b...

  19. Social Costs of Herbicide Resistance: The Case of Resistance to Glyphosate

    OpenAIRE

    Marsh, Sally P.; Llewellyn, Rick S.; Powles, Stephen B.

    2006-01-01

    Unlike in the pesticide and antibiotic resistance literature, potential social costs and externalities associated with herbicide resistance have not generally been considered by economists. The economics of managing herbicide resistance in weeds has focused on cost-effective responses by growers to the development of resistance at the individual farm and field level. Economic analyses of optimal herbicide use have focused on optimising farmer returns in the long run. Weeds have been considere...

  20. Measuring the costs of biosecurity on poultry farms: a case study in broiler production in Finland

    OpenAIRE

    Siekkinen Kirsi-Maarit; Heikkilä Jaakko; Tammiranta Niina; Rosengren Heidi

    2012-01-01

    Abstract Background Farm-level biosecurity provides the foundation for biosecurity along the entire production chain. Many risk management practices are constantly in place, regardless of whether there is a disease outbreak or not. Nonetheless, the farm-level costs of preventive biosecurity have rarely been assessed. We examined the costs incurred by preventive biosecurity for Finnish poultry farms. Methods We used a semi-structured phone interview and obtained results from 17 broiler produce...

  1. Evaluation of Cost-Effectiveness Criteria in Supply Chain Management: Case Study

    OpenAIRE

    Reza Rostamzadeh; Mahdi Sabaghi; Ahmad Esmaili

    2013-01-01

    The aim of this paper is to evaluate and prioritize the proposed cost-effectiveness criteria in supply chain management using fuzzy multiple attribute decision-making (MADM) approach. Over the past few years, the determination of suitable cost-effectiveness criteria in the supply chain has become a key strategic issue. However, the nature of these kinds of decisions is usually complex and unstructured. Many quantitative and qualitative factors must be considered to determine the suitable crit...

  2. TRANSPORTATION MODAL CHOICE IN COOLANT IMPORTATION THROUGH TOTAL COSTS MINIMIZATION: A CASE STUDY

    Directory of Open Access Journals (Sweden)

    Marcela de Souza Leite

    2016-07-01

    Full Text Available Transportation plays a very significant role when it comes to the costs of a company representing on average 60% of logistics costs, so its management is very important for any company. The transportation modal choice is one of the most important transportation decisions. The purpose of this article is to select the transportation mode which is able to minimize total costs, and consistent with the objectives of customer service on the coolant import, which is used in plasma cutting machines. With the installation of a distribution center in Brazil and the professionalization of the logistics department of the company, it was decided to re-evaluate the transportation mode previously chosen to import some items. To determine the best mode of transportation was used basic compensation costs, in other words the cost compensation of using the shuttle service to the indirect cost of inventory related to the modal performance. Through the study, it was possible to observe it may be possible to save up to 73% on the coolant international transportation by changing the transportation mode used by the company.

  3. Cost-Benefit Analysis for Energy Management in Public Buildings: Four Italian Case Studies

    Directory of Open Access Journals (Sweden)

    Davide Astiaso Garcia

    2016-07-01

    Full Text Available Improving energy efficiency in public buildings is one of the main challenges for a sustainable requalification of energy issues and a consequent reduction of greenhouse gas (GHG emissions. This paper aims to provide preliminary information about economic costs and energy consumption reductions (benefits of some considered interventions in existing public buildings. Methods include an analysis of some feasible interventions in four selected public buildings. Energy efficiency improvements have been assessed for each feasible intervention. The difference of the building global energy performance index (EPgl has been assessed before and after each intervention. Economic costs of each intervention have been estimated by averaging the amount demanded by different companies for the same intervention. Results obtained show economic costs and the EPgl percentage improvement for each intervention, highlighting and allowing for the comparison of energy consumption reduction and relative economic costs. The research results come from data gathered from four public buildings, and as such they could not be used to generically identify cost-beneficial energy efficiency interventions for every context or building type. However, the data reveals useful cost based considerations for selecting energy efficiency interventions in other public buildings.

  4. The impact of intellectual capital disclosure on cost of equity capital: A case of French firms

    Directory of Open Access Journals (Sweden)

    Mohamed Ali Boujelbene

    2013-06-01

    Full Text Available The purpose of this paper is to examine empirically the impact of intellectual capital disclosure (IC on cost of Equity capital. The empirical research is based on companies listed in the French SBF 120 stock market index. The findings confirm our hypotheses that stipulate the existence of a significant and negative association between intellectual capital disclosure with its two components (human capital, structural and the cost of equity. However, the negative impact of the relational capital disclosure is not validated. The results in this paper are of considerable importance to both policy makers and firms. In fact, the understanding of the impact of Intellectual capital disclosure on cost of equity capital helps policy makers in the evaluation of the costs and benefits of disclosure. Moreover, with regard to managers of firms, the results show the benefit of enhanced IC disclosure regarding the reduction in their cost of capital. This study is one of the very first to provide empirical evidence of the association between Cost of equity capital and the level of disclosure in the three individual intellectual capital categories (human; structural and relational capital.

  5. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

    Full Text Available Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain for the year 2012 (N = 92,498 individuals. A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG patient classification system. Results: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. Conclusion: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

  6. Giant osteoma of the skull vault: A rare case of mixed variety

    Directory of Open Access Journals (Sweden)

    Harisha P.N.

    2016-12-01

    Full Text Available Osteoma is the most common primary bone tumor in the craniofacial skeleton. However, most of these are small, asymptomatic and arise from the facial bones or in relation to the paranasal sinuses. Cranial vault osteomas, that too giant and symptomatic are much rarer. We report a case of sixty year-old gentleman presented with a very slowly increasing, painless, hard swelling on the left side of his head. Computerized tomography scan showed the left parietal calvarial tumor to be having large exostotic and enostotic components. He underwent an en-bloc excision of the tumor and cranioplasty. Giant, symptomatic cranial vault osteoma with concurrent exostotic and enostotic components is extremely rare. These lesions can be safely and completely excised with careful planning and attention to detail.

  7. Correction of Multiple Canine Impactions by Mixed Straightwire and Cantilever Mechanics: A Case Report

    Directory of Open Access Journals (Sweden)

    Sergio Paduano

    2014-01-01

    Full Text Available Background. This case report describes the orthodontic treatment of a woman, aged 17 years, with a permanent dentition, brachyfacial typology, Angle Class I, with full impaction of two canines (13,33, and a severe ectopy of the maxillary left canine. Her main compliant was the position of the ectopic teeth. Methods. Straightwire fixed appliances, together with cantilever mechanics, were used to correct the impaired occlusion and to obtain an ideal torque control. Results and Conclusion. The treatment objectives were achieved in 26 months of treatment. The impactions were fully corrected with an optimal torque. The cantilever mechanics succeeded in obtaining tooth repositioning in a short lapse of time. After treatment, the dental alignment was stable.

  8. Documenting Elementary Teachers' Sustainability of Instructional Practices: A Mixed Method Case Study

    Science.gov (United States)

    Cotner, Bridget A.

    School reform programs focus on making educational changes; however, research on interventions past the funded implementation phase to determine what was sustained is rarely done (Beery, Senter, Cheadle, Greenwald, Pearson, et al., 2005). This study adds to the research on sustainability by determining what instructional practices, if any, of the Teaching SMARTRTM professional development program that was implemented from 2005--2008 in elementary schools with teachers in grades third through eighth were continued, discontinued, or adapted five years post-implementation (in 2013). Specifically, this study sought to answer the following questions: What do teachers who participated in Teaching SMARTRTM and district administrators share about the sustainability of Teaching SMARTRTM practices in 2013? What teaching strategies do teachers who participated in the program (2005--2008) use in their science classrooms five years postimplementation (2013)? What perceptions about the roles of females in science, technology, engineering, and mathematics (STEM) do teachers who participated in the program (2005--2008) have five years later (2013)? And, What classroom management techniques do the teachers who participated in the program (2005--2008) use five years post implementation (2013)? A mixed method approach was used to answer these questions. Quantitative teacher survey data from 23 teachers who participated in 2008 and 2013 were analyzed in SAS v. 9.3. Descriptive statistics were reported and paired t-tests were conducted to determine mean differences by survey factors identified from an exploratory factor analysis, principal axis factoring, and parallel analysis conducted with teacher survey baseline data (2005). Individual teacher change scores (2008 and 2013) for identified factors were computed using the Reliable Change Index statistic. Qualitative data consisted of interviews with two district administrators and three teachers who responded to the survey in both

  9. Integrated cost-effectiveness analysis of greenhouse gas emission abatement. The case of Finland

    Energy Technology Data Exchange (ETDEWEB)

    Lehtilae, A.; Tuhkanen, S. [VTT Energy, Espoo (Finland). Energy Systems

    1999-11-01

    In Finland greenhouse gas emissions are expected to increase during the next decades due to economic growth, particularly in the energy intensive industrial sectors. The role of these industries is very central in the national economy. The emission control according to the Kyoto Protocol will therefore be quite difficult and costly. The study analyses the cost-effectiveness of different technical options for reducing the emissions of carbon dioxide, methane, and nitrous oxide in Finland. The analysis is performed with the help of a comprehensive energy system model for Finland, which has been extended to cover all major sources of methane and nitrous oxide emissions in the energy sector, industry, waste management and agriculture. The focus being on technical options, no consideration is given to possible policy measures, emission trading or joint implementation in the study. Under the boundary conditions given for the development of the Finnish energy economy, cost-effective technical measures in the energy system include increases in the use of wood biomass, natural gas and wind energy, increases in the contribution of CHP to the power supply, and intensified energy conservation in all end-use sectors. Additional cost-effective measures are landfill gas recovery, utilisation of the combustible fraction of waste and catalytic conversion of N{sub 2}O in nitric acid production. With baseline assumptions, the direct annual costs of emission abatement are calculated to be about 2000 MFIM (330 M{epsilon}) in 2010. The marginal costs are estimated to be about 230 FIM (40 {epsilon}) per tonne of CO{sub 2}-equivalent in 2010. The cost curie derived from the analysis could be used in further analyses concerning emissions trading. (orig.) 109 refs. SIHTI Research Programme

  10. IEA Wind Task 26 - Multi-national Case Study of the Financial Cost of Wind Energy; Work Package 1 Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Schwabe, P.; Lensink, S.; Hand, M.

    2011-03-01

    The lifetime cost of wind energy is comprised of a number of components including the investment cost, operation and maintenance costs, financing costs, and annual energy production. Accurate representation of these cost streams is critical in estimating a wind plant's cost of energy. Some of these cost streams will vary over the life of a given project. From the outset of project development, investors in wind energy have relatively certain knowledge of the plant's lifetime cost of wind energy. This is because a wind energy project's installed costs and mean wind speed are known early on, and wind generation generally has low variable operation and maintenance costs, zero fuel cost, and no carbon emissions cost. Despite these inherent characteristics, there are wide variations in the cost of wind energy internationally, which is the focus of this report. Using a multinational case-study approach, this work seeks to understand the sources of wind energy cost differences among seven countries under International Energy Agency (IEA) Wind Task 26 - Cost of Wind Energy. The participating countries in this study include Denmark, Germany, the Netherlands, Spain, Sweden, Switzerland, and the United States. Due to data availability, onshore wind energy is the primary focus of this study, though a small sample of reported offshore cost data is also included.

  11. Costing a feminist plan for a caring economy: The case of free universal childcare in the UK

    OpenAIRE

    de Henau, Jerome

    2015-01-01

    This paper makes the case for providing universal and free childcare services in the UK to contribute to building a care economy as a better alternative to austerity and spending cuts, one that would foster gender equality and quality employment. It estimates the total cost of such services using different assumptions on staff pay and coverage and the related direct employment effects. It discusses the different multipliers that could be derived from such 'investment' and the related tax reve...

  12. Estimating the implied cost of carbon in future scenarios using a CGE model: The Case of Colorado

    Energy Technology Data Exchange (ETDEWEB)

    Hannum, Christopher; Cutler, Harvey; Iverson, Terrence; Keyser, David

    2017-03-01

    Using Colorado as a case study, we develop a state-level computable general equilibrium (CGE) model that reflects the roles of coal, natural gas, wind, solar, and hydroelectricity in supplying electricity. We focus on the economic impact of implementing Colorado's existing Renewable Portfolio Standard, updated in 2013. This requires that 25% of state generation come from qualifying renewable sources by 2020. We evaluate the policy under a variety of assumptions regarding wind integration costs and assumptions on the persistence of federal subsidies for wind. Specifically, we estimate the implied price of carbon as the carbon price at which a state-level policy would pass a state-level cost-benefit analysis, taking account of estimated greenhouse gas emission reductions and ancillary benefits from corresponding reductions in criteria pollutants. Our findings suggest that without the Production Tax Credit (federal aid), the state policy of mandating renewable power generation (RPS) is costly to state actors, with an implied cost of carbon of about $17 per ton of CO2 with a 3% discount rate. Federal aid makes the decision between natural gas and wind nearly cost neutral for Colorado.

  13. Potentials for Improvement of Resource Efficiency in Printed Circuit Board Manufacturing: A Case Study Based on Material Flow Cost Accounting

    Directory of Open Access Journals (Sweden)

    Yi-Xuan Wang

    2017-05-01

    Full Text Available The pursuit of sustainable resource use by manufacturing companies is driven by resource scarcity, environmental awareness, and cost savings potentials. To address these issues, Material Flow Cost Accounting (MFCA has been developed and applied as an effective environmental management tool. Within MFCA’s general allocation, the accounts of products and losses are overrated by weight or volume. However, such a method is incompatible with Printed Circuit Board (PCB manufacturing because of industry characteristics in which primary inputs and products are measured by area. Based on MFCA, this case study systematically established several linear cost calculation models along the production process for capturing the actual waste flows as well as performing cost-benefit analysis. The recognition of previously ignored losses offered the incentive to find appropriate indicators to conduct cost-benefit analysis on hotspots for losses. Loss identification and analysis indicated that machining and wiring are the necessities and priorities of process optimization for resource efficiency improvement measures. Therefore, this research could not only advance the achievement of a profitable and sustainable production while improving resource efficiency at the source but could also provide support for decision making in PCB manufacturing.

  14. Opposite Drug Prescription and Cost Trajectories following Integrative and Conventional Care for Pain – A Case-Control Study

    Science.gov (United States)

    Sundberg, Tobias; Petzold, Max; Kohls, Niko; Falkenberg, Torkel

    2014-01-01

    Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC. PMID:24827981

  15. Avoided costs associated with cogeneration: a case study of Con Ed

    Energy Technology Data Exchange (ETDEWEB)

    Bright, R.; Davitian, H.; Martorella, J.

    1980-08-01

    The potential impact of cogeneration in office and apartment buildings in New York City on the Consolidated Edison Company (Con Ed) has been investigated using a method of utility cost and fuel use analysis developed at Brookhaven National Laboratory. This method computes a utility's long run marginal costs and long run marginal fuel consumption associated with load modifications due to the introduction of on-site energy producing technologies. The principal findings of this study show that Con Ed's long run average cost is more likely to go down than up due to cogeneration in office and apartment building; the utility's avoided costs (i.e., its long run marginal savings) associated with the gross power output of the cogeneration systems are 10.5 cents/KWh for the office building and 6.4 cents/KWh for the apartment buildings; the utility's marginal savings include a component for avoided capacity costs; and there are net savings in the use of oil due to cogeneration (assuming the building used oil for its boilers before it switched and diesel fuel in its cogenerators afterwards).

  16. Evaluating the cost-effectiveness of ecosystem-based adaptation: Kamiesberg wetlands case study

    Directory of Open Access Journals (Sweden)

    David Black

    2016-12-01

    Full Text Available Ecosystem-based adaptation (EbA is increasingly being promoted as a cost-effective means of adaptation to climate change. However, in spite of considerable international press, there is still little evidence to substantiate this claim. This study proposes a method through which the cost-effectiveness of EbA strategies can be evaluated against alternative adaptation options, and contributes to South African literature on the subject. The potential cost-effectiveness of wetland restoration is assessed as a means of securing the carrying capacity of land for pastoralist communities of the Kamiesberg communal area in South Africa under projected future climate conditions. The conventional alternatives would be to respond to increasingly dry conditions by drilling boreholes and using supplemental feed for livestock. It was assumed that the EbA interventions would occur upfront, whereas the alternatives are more likely to be implemented in reaction to droughts over a longer time period. The study found the implementation of conventional alternatives to be more cost-effective than EbA as a means to sustaining livestock stocking rates, with EbA being twice as costly. However, this is framed from the perspective of those directly affected (the landowners, and does not include the benefits to broader society.

  17. A study on effect of outsourcing on cost reduction: A case study of tile industry

    Directory of Open Access Journals (Sweden)

    Amir Reza Shirzadeh

    2014-01-01

    Full Text Available During the past few decades, many organizations have attempted to reduce their costs through outsourcing of non-value added activities. This paper presents an empirical investigation to find important factors on reducing production expenses through outsourcing activities. The proposed study of this paper designs a questionnaire in Likert scale consists of 19 questions and distributes it among some experts. Using structural equation modeling, the study investigates different variables and the results indicate that outsourcing could reduce the production cost through time, inventory and human resources. The implementation of Freedman for ranking these factors indicate that time played the most influential factor followed by inventory and human resources. The results of structural equation modeling indicate that there are some positive and meaningful relationship between human capital and cost (β=0.78, t-value = 9.38, a positive and meaningful relationship between inventory and cost (β=0.81, t-value=10.54 and a positive and meaningful relationship between time and cost (β=0.89, t-value = 11.26.

  18. Transaction costs and marketing decision: a case study of smallholder tomato farmers in Makurdi, Nigeria

    Directory of Open Access Journals (Sweden)

    Samuel O. Osebeyo

    2014-01-01

    Full Text Available This study examined the impact of transaction costs and other institutional and socio-economic factors on smallholder tomato farmers marketing decision in Makurdi Local Government Area, Benue State, Nigeria. The study used a survey data from 165 randomly selected farm households. Using a Logit model, the study found that the probability of market participation is significantly affected by transaction cost variables (namely access to market information, market distance and transport cost. Education and dependency ratio also had significant effect on decision to sell in the market. While access to market information and education significantly increase the probability of tomato farmers’ participation in the market, transport cost, market distance and dependency ratio significantly decrease the probability. The study stresses the need for government intervention by means of providing the necessary infrastructures that will help to reduce transaction costs and thus increase farmers’ participation in the market. Also policies to provide adequate and timely information about the market situations as well as polices to enhance access to education are advocated.

  19. Outdoor Environment of Low-cost Housing: A case study of Flat Taman Desa Sentosa

    Directory of Open Access Journals (Sweden)

    Mohamed Mohd Farid

    2014-01-01

    Full Text Available One of the early objectives of high-density low-cost flat housing is to overcome the squatter problems in urban areas such as in Kuala Lumpur. As the country progresses towards being a developed nation, the quality and standard of living of its people have also improved. Low-cost flat housing initiative has also gone through changes to provide better living quality. This paper discusses on the occupants’ satisfaction perception of outdoor environmental quality (OEQ of a selected high-density low-cost flat housing located in the state of Selangor in Malaysia. The objective of the paper is to obtain the level of perception by the occupants of low-cost flats on the OEQ. The methodologies used in this study are site observation and questionnaire survey. This study found that the OEQ in the low-cost flat has generally fulfilled the five out of 6 elements of OEQ. The only element that found to have poor perception is the level of safety.

  20. Unusual case of mixed form of femoroacetabular impingement combined with nonspecyfic synovitis of the hip joint in a young adult: A case report

    Directory of Open Access Journals (Sweden)

    Mladenović Marko

    2015-01-01

    Full Text Available Introduction. Minimal bone changes in the acetabulum and/or proximal femur, through mechanism known as femoroacetabular impingement, during flexion, adduction and internal rotation lead to early contact between femoral head-neck junction and acetabular brim, in anterosuperior region. Each additional pathological substrate which further decreases specified clearance provokes earlier onset of femoroacetabular impingement symptoms. Case report. We presented a 20-year-old male patient with groin pain, limping, positive impingement test, radiological signs of mixed form of femoroacetabular impingement and unrecognized chronic hypertrophic synovitis with earlier development of clinical hip symptoms than it has been expected. Open surgery of the left hip was done. Two years after the surgery, patient was asymptomatic, painless, and free of motion, with stable x-rays. Conclusion. Hypertrophic synovial tissue further reduces the distance between the femoral head-neck junction and the acetabulum, leading to the earlier onset of femoroacetabular impingement symptoms. Surgical treatment is the method of choice.

  1. Improving and measuring inpatient documentation of medical care within the MS-DRG system: education, monitoring, and normalized case mix index.

    Science.gov (United States)

    Rosenbaum, Benjamin P; Lorenz, Robert R; Luther, Ralph B; Knowles-Ward, Lisa; Kelly, Dianne L; Weil, Robert J

    2014-01-01

    Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the "normalized case mix index," that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved.

  2. Activity-based Management of Logistic Costs in a Manufacturing Company: A Case of Increased Visibility of Logistics Costs in a Slovenian Paper Manufacturing Company

    Directory of Open Access Journals (Sweden)

    Julijana Krajnc

    2012-01-01

    Full Text Available Both the transparent reporting of logistics costs and the related accounting of their cost drivers present a significant factor for the successful management of material flows and the related logistics activities in production companies. These costs, which are mainly reported as part of overhead (indirect costs in such companies, usually remain hidden or are not explicitly visible when the traditional method of accounting is applied. The aim of this research is to create a model of activity-based accounting of logistics costs in a production company, and to test its efficiency in the disclosure of logistics costs compared with traditional cost accounting. The application of the model in a production company shows that an activity-based approach discloses as much as 108% more logistics costs at the level of a group of products than the traditional cost-accounting approach. Further, detailed information on logistics costs obtained in this way enables their more efficient management. Key words: logistics costs; activity-based costing; cost allocation; cost visibility; cost management

  3. Reducing Inbound Logistics Costs- A Case Study in the Chinese Automobile Industry

    OpenAIRE

    Feng, Mengying

    2006-01-01

    Globalization has made company competition more intense. Supply chain management has developed to enable companies to compete effectively. Logistics supports competitiveness of the supply chain as a whole by meeting customer demand both timely and at a competitive cost and inbound logistics cost management is considered to be a priority in reducing costs. As the Chinese automobile industry is ChinaÃ�Æ�Ã�Æ�Ã�â��Ã�Æ�Ã�Æ�Ã�â��Ã�â��Ã�¢Ã�Æ�Ã�Æ�Ã�â��Ã�â��Ã�Æ�Ã�â��Ã�â��Ã�â�¬Ã�Æ�Ã�Æ�Ã�â��Ã�â��Ã...

  4. Cost-effectiveness of policies aimed at increasing organ donation: the case of Chile.

    Science.gov (United States)

    Domínguez, J; Harrison, R; Atal, R; Larraín, L

    2013-01-01

    In this article we present an economic evaluation of policies aimed at increasing deceased organ donation in Chile, a developing country that has low donation rates; it had 5.4 donors per million people (pmp) in 2010. Expert opinions of leading participants in donation and transplantation were analyzed, resulting in a set of local policies aimed at increasing donation rates. Using previous results of reported cost savings of increasing kidney transplantation in Chile, we estimated the net benefits of these policies, as a function of additional donors. The main problem of the Chilean system seems to be the low capability to identify potential donors and a deficit in intensive care unit (ICU) beds. Among considered policies central to increase donation are the following: increasing human and capital resources dedicated to identifying potential donors, providing ICU beds from private centers, and developing an online information system that facilitates procurement coordination and the evaluation of performance at each hospital. Our results show that there is a linear relationship between cost savings and incremental donors pmp. For example, if these policies are capable of elevating donation rates in Chile by 6 donors pmp net estimated cost savings are approximately US $1.9 million. Likewise, considering the effect on patients' quality of life, savings would amount to around $15.0 million dollars per year. Our estimates suggest that these policies have a large cost-saving potential. In fact, considering implementation costs, cost reduction is positive after 4 additional donors pmp, and increasing afterward. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Outdoor Environment of Low-cost Housing: A case study of Flat Taman Desa Sentosa

    OpenAIRE

    Mohamed Mohd Farid; Raman Sudharshan N.; Iman Pratama Tito Maulana; Mohammad Yusoff Wardah Fatimah

    2014-01-01

    One of the early objectives of high-density low-cost flat housing is to overcome the squatter problems in urban areas such as in Kuala Lumpur. As the country progresses towards being a developed nation, the quality and standard of living of its people have also improved. Low-cost flat housing initiative has also gone through changes to provide better living quality. This paper discusses on the occupants’ satisfaction perception of outdoor environmental quality (OEQ) of a selected high-density...

  6. Complexity Management - A multiple case study analysis on control and reduction of complexity costs

    DEFF Research Database (Denmark)

    Myrodia, Anna

    of products, with features more custom-made to cover individual needs, both regarding characteristics of products and support services. This necessity leads to a considerable increase of the complexity in the company, which affects the product portfolio, production and supply chain, market segments...... product and process complexity. The possible factors for describing this correlation are identified and defined as complexity cost factors (CCFs). By identifying the CCFs this research intends to analyze the most relevant processes where the complexity and cost are directly related to the complexity...

  7. Production Rate and Weapon System Cost: Research Review, Case Studies, and Planning Model.

    Science.gov (United States)

    1980-11-01

    number of diphones is now 2733. Generalized the phonetic synthesis program to allow the use of phonological rules combined with diphone templates...Projects Agency under ARPA Order No. 3515. 19. KEY WORoS (Continue on ,evere.s ide It n*.Ceew mid Identify by block number) Speech synthesis, phonetic ...real-time vocoder, mixed-source excitation model, adaptive lattice, phonetic vocoder, spectral template, 20. AU ,RAkCT (Conitinue On reverse eld* It

  8. New Option Pricing about Underlying Asset Pricing Process by Mixed Process with Transaction Cost%有交易成本的标的资产服从混合过程的新型期权定价

    Institute of Scientific and Technical Information of China (English)

    乔克林; 蒋登智; 李晋枝

    2012-01-01

    On the definition of transaction costs and dividends, by changing basic assumption of Black-Scholes option pricing model to the assume that underlying asset complies with mixed process. Using the method of portfolio combination to simulation options gains, get rainbow option pricing equation about underlying asset pricing process by mixed process with transaction cost and dividends, and many factors option pricing equation.%在有交易成本和红利的基础上,改变Black-Scholes期权定价模型的基本假设,认为标的资产是服从混合过程,运用证券组合模拟期权收益的方法,得到有交易成本和红利的标的资产服从混合过程的彩虹期权定价方程,以及多因素期权定价方程.

  9. SPRAY FOAM IN ACCESSIBLE SPACES:BEST PRACTICES AND CASE STUDIES FOR RETROFIT IN MIXED-HUMID CLIMATE

    Energy Technology Data Exchange (ETDEWEB)

    Christian, Jeffrey E [ORNL; Gant, Kathy [Oak Ridge National Laboratory (ORNL)

    2013-12-01

    Heating and cooling the house is one of the homeowners major expenses. Reducing these costs, saving energy, and creating a healthier, more comfortable indoor environment are good reasons to consider improving the building thermal envelope. Improvements usually consider increasing the amount of insulation, reducing the infiltration of outside air, and controlling moisture in existing buildings. This report describes the use of spray foam materials to insulate, seal, and control moisture. This discussion is limited to treating areas that are accessible. What is accessible, however, can vary depending on the type of renovation. If the building has been gutted or exterior surfaces removed, there are more options. This report will look at areas to consider for spray foam application and discuss the types of spray foams available and their uses. A number of case studies are presented to show the effectiveness of this retrofit in existing houses based on performance data.

  10. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...... to facilitate resource planning and earnings forecasting. As such, this dissertation relates to the topic of firm profitability and the interpretation of cost variability. The dissertation consists of three parts that are written in the form of separate academic papers. The following section briefly summarizes...

  11. Cost vs. Market Value: The Case for Reporting Endowment Investments at Market Value.

    Science.gov (United States)

    Bland, Harold

    1992-01-01

    The difference between cost and market value of endowment investments is significant for many colleges and universities. These investments should always be reported at market value to provide relevant, comparable, consistent, and understandable financial information. Nonmanagement users of institutional financial statements prefer market rather…

  12. Multi-Product Total Cost Functions for Higher Education: The Case of Chinese Research Universities

    Science.gov (United States)

    Longlong, Hou; Fengliang, Li; Weifang, Min

    2009-01-01

    This paper empirically investigates the economies of scale and economies of scope for the Chinese research universities by employing the flexible fixed cost quadratic (FFCQ) function. The empirical results show that both economies of scale and economies of scope exist in the Chinese higher education system and support the common belief of…

  13. Assessing the costs of land degradation: a case study for the Puentes catchment, South East Spain

    NARCIS (Netherlands)

    Hein, L.G.

    2007-01-01

    Whereas many studies point out the economic benefits of controlling land degradation through sustainable land management (SLM) approaches, there is often a lack of local adoption of SLM techniques. Analysis of the local impacts and costs of land degradation is critical for understanding farmers' res

  14. Cost and efficiency of disaster waste disposal: A case study of the Great East Japan Earthquake.

    Science.gov (United States)

    Sasao, Toshiaki

    2016-12-01

    This paper analyzes the cost and efficiency of waste disposal associated with the Great East Japan Earthquake. The following two analyses were performed: (1) a popular parametric approach, which is an ordinary least squares (OLS) method to estimate the factors that affect the disposal costs; (2) a non-parametric approach, which is a two-stage data envelopment analysis (DEA) to analyze the efficiency of each municipality and clarify the best performance of the disaster waste management. Our results indicate that a higher recycling rate of disaster waste and a larger amount of tsunami sediments decrease the average disposal costs. Our results also indicate that area-wide management increases the average cost. In addition, the efficiency scores were observed to vary widely by municipality, and more temporary incinerators and secondary waste stocks improve the efficiency scores. However, it is likely that the radioactive contamination from the Fukushima Daiichi nuclear power station influenced the results. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Estimating health damage cost from secondary sulfate particles - a case study of Hunan Province,China

    Institute of Scientific and Technical Information of China (English)

    HAO Ji-ming; LI Ji; YE Xue-mei; ZHU Tian-le

    2003-01-01

    China's coal-dominated energy pattern has resulted in large amount of SO2 emissions. Estimate of the sulfur-related health damage cost is necessary to help perform systematic cost-benefit analysis and set national energy and emissions control priorities. Current researches were confined to gaseous SO2 in urban areas; however, secondary sulfate (SO42-) particles can exert serious impact in a wider region. Based on the concept of "intake fraction", CALPUFF long-range dispersion model and 180 sample emission sources, multiple regression equation was obtained with good correlation(r=0.85), which illustrates that populations were key parameters to determine intake fraction but source characteristics were insignificant. Based on the formula and the population distribution data, county-level intake fractions were mapped for Hunan Province(range: 1.1×10-6-3.2×10-6) of China. A combination of county-level SO2 emissions with the intake fractions yields a total 1.98 tons of sulfate(SO42-) inhalation, and resulting total health damage cost to be 0.76(willingness to pay approach) or 0.16(human capital approach) billion USD in 1997, about 2.1% or 0.45% of GDP in Hunan in 1997. Average health damage cost per ton of SO2 emission is 930(willingness to pay approach) or 200 USD(human capital approach). The results demonstrated that more stringent regulation should be forced.

  16. A Minimum-Cost Network-Flow Solution to the Case v Thurstone Scaling Problem.

    Science.gov (United States)

    Lattin, James M.

    1990-01-01

    An approach is presented for determining unidimensional scale estimates that are relatively insensitive to limited inconsistencies in paired comparisons data. The solution procedure--a minimum-cost network-flow problem--is presented in conjunction with a sensitivity diagnostic that assesses the influence of a single pairwise comparison on…

  17. Comments on "Opportunity Cost: A Reexamination": A Case in Point of No Free Lunch

    Science.gov (United States)

    Stone, Daniel F.

    2016-01-01

    Ferraro and Taylor (2005) and Potter and Sanders (2012) have sparked a debate about the definition of opportunity cost (OC). This is, of course, ostensibly a very basic term, but Ferraro and Taylor said that most economists do not readily know its correct definition, and Potter and Sanders argued that this can be explained by the fact that there…

  18. Total cost of ownership in the services sector: A case study

    NARCIS (Netherlands)

    K. Hurkens (Krisje); W. van der Valk (Wendy); J.Y.F. Wynstra (Finn)

    2006-01-01

    textabstractFew detailed studies exist of the trade-offs to be made when developing a comprehensive, strategically focused total cost of ownership (TCO) model. Moreover, most studies of TCO have been conducted in manufacturing firms, with little or no TCO research directed toward service organizatio

  19. Econometrics of inventory holding and shortage costs: the case of refined gasoline

    Energy Technology Data Exchange (ETDEWEB)

    Krane, S.D.

    1985-01-01

    This thesis estimates a model of a firm's optimal inventory and production behavior in order to investigate the link between the role of inventories in the business cycle and the microeconomic incentives for holding stocks of finished goods. The goal is to estimate a set of structural cost function parameters that can be used to infer the optimal cyclical response of inventories and production to shocks in demand. To avoid problems associated with the use of value based aggregate inventory data, an industry level physical unit data set for refined motor gasoline is examined. The Euler equations for a refiner's multiperiod decision problem are estimated using restrictions imposed by the rational expectations hypothesis. The model also embodies the fact that, in most periods, the level of shortages will be zero, and even when positive, the shortages are not directly observable in the data set. These two concerns lead us to use a generalized method of moments estimation technique on a functional form that resembles the formulation of a Tobit problem. The estimation results are disappointing; the model and data yield coefficient estimates incongruous with the cost function interpretations of the structural parameters. These is only some superficial evidence that production smoothing is significant and that marginal inventory shortage costs increase at a faster rate than do marginal holding costs.

  20. Multi-Product Total Cost Functions for Higher Education: The Case of Chinese Research Universities

    Science.gov (United States)

    Longlong, Hou; Fengliang, Li; Weifang, Min

    2009-01-01

    This paper empirically investigates the economies of scale and economies of scope for the Chinese research universities by employing the flexible fixed cost quadratic (FFCQ) function. The empirical results show that both economies of scale and economies of scope exist in the Chinese higher education system and support the common belief of…

  1. Potential cost-effectiveness of schistosomiasis treatment for reducing HIV transmission in Africa--the case of Zimbabwean women.

    Directory of Open Access Journals (Sweden)

    Martial L Ndeffo Mbah

    Full Text Available BACKGROUND: Epidemiological data from Zimbabwe suggests that genital infection with Schistosoma haematobium may increase the risk of HIV infection in young women. Therefore, the treatment of Schistosoma haematobium with praziquantel could be a potential strategy for reducing HIV infection. Here we assess the potential cost-effectiveness of praziquantel as a novel intervention strategy against HIV infection. METHODS: We developed a mathematical model of female genital schistosomiasis (FGS and HIV infections in Zimbabwe that we fitted to cross-sectional data of FGS and HIV prevalence of 1999. We validated our epidemic projections using antenatal clinic data on HIV prevalence. We simulated annual praziquantel administration to school-age children. We then used these model predictions to perform a cost-effectiveness analysis of annual administration of praziquantel as a potential measure to reduce the burden of HIV in sub-Saharan Africa. FINDINGS: We showed that for a variation of efficacy between 30-70% of mass praziquantel administration for reducing the enhanced risk of HIV transmission per sexual act due to FGS, annual administration of praziquantel to school-age children in Zimbabwe could result in net savings of US$16-101 million compared with no mass treatment of schistosomiasis over a ten-year period. For a variation in efficacy between 30-70% of mass praziquantel administration for reducing the acquisition of FGS, annual administration of praziquantel to school-age children could result in net savings of US$36-92 million over a ten-year period. CONCLUSIONS: In addition to reducing schistosomiasis burden, mass praziquantel administration may be a highly cost-effective way of reducing HIV infections in sub-Saharan Africa. Program costs per case of HIV averted are similar to, and under some conditions much better than, other interventions that are currently implemented in Africa to reduce HIV transmission. As a cost-saving strategy, mass

  2. Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report

    Directory of Open Access Journals (Sweden)

    Tufan Ali

    2012-06-01

    Full Text Available Abstract Vitamin B12 is one of the essential vitamins affecting various systems of the body. Reports of psychiatric disorders due to its deficiency mostly focus on middle aged and elderly patients. Here we report a case of vitamin B 12 deficiency in a 16-year old, male adolescent who presented with mixed mood disorder symptoms with psychotic features. Chief complaints were “irritability, regressive behavior, apathy, crying and truancy” which lasted for a year. Premorbid personality was unremarkable with no substance use/exposure or infections. No stressors were present. The patient was not vegetarian. Past medical history and family history was normal. Neurological examination revealed glossitis, ataxia, rigidity in both shoulders, cog-wheel rigidity in the left elbow, bilateral problems of coordination in cerebellar examination, reduced swinging of the arms and masked face. Romberg’s sign was present. Laboratory evaluations were normal. Endoscopy and biopsy revealed atrophy of the gastric mucosa with Helicobacter Pylori colonization. Schilling test was suggestive of malabsorbtion. He was diagnosed with Mood disorder with Mixed, Psychotic Features due to Vitamin B12 Deficiency and risperidone 0.5 mg/day and intramuscular vitamin B12 500 mcg/day were started along with referral for treatment of Helicobacter pylori. A visit on the second week revealed no psychotic features. Romberg’s sign was negative and cerebellar tests were normal. Extrapyramidal symptoms were reduced while Vitamin B12 levels were elevated. Risperidone was stopped and parenteral Vitamin B12 treatment was continued with monthly injections for 3 months. Follow-up endoscopy and biopsy at the first month demonstrated eradication of H. pylori. He was followed monthly for another 6 months and psychiatric symptoms did not recur at the time of last evaluation. Despite limitations, this case may underline the observation that mood disorders with psychotic features

  3. Measuring customer profitability through time-driven activity-based costing: a case study at hotel x Jogjakarta

    Directory of Open Access Journals (Sweden)

    Billy Ardiansyah Garry

    2017-01-01

    Full Text Available Travelling intensity has been higher in the past few years making hospitality industry must be ready to provide the best service at optimum prices to customers who purchase and enjoy the services. Hotel as one of the accommodation service providers should be able to allocate resources accurately according to the actual needed capacity and thorough tariff policy for not losing the competition and obtain profit according to how much is projected. TDABC system is the most updated costing system which can assist the allocation of these resources. TDABC system is considered twice important to be applied in the service industry as service is intangible so costing system must show the exact and accurate number of resources used to provide the service. Through TDABC system, Customer Profitability Analysis is conducted with the aim of knowing the level of profitability every customer type possesses and classifying them as profitable or non-profitable customers. A case study had been conducted in a five-star hotel located in the Special Region of Jogjakarta resulting a profit recognized under TDABC system that traditional method used as the hotel’s costing system failed to do so and more proper data on costs and profitability of customers.

  4. THE ROLE OF TIPPING IN REDUCING LABOUR COSTS: CASE OF SECTOR RETAIL PETROLEUM PRODUCTS

    Directory of Open Access Journals (Sweden)

    Andrej Raspor

    2014-05-01

    Full Text Available The purpose of this paper was to determine whether tipping could reduce labour costs in the petroleum products retail sector. The research we present was designed on the basis of survey results gathered from Slovenian petrol stations in 2009 and 2010. We have identified the following factors in the tipping process: job satisfaction, flexibility, service quality, satisfaction, motivation and the factor of receiving tips. The analysis showed correlation between methods used to increase the value of tips and better service quality, increased financial and numerical flexibility, motivation, satisfaction upon receipt of tips and the method used to increase the value of tips. In order to decrease labour costs we propose that the management take control of tipping and integrates tips into the reward system. Also, the employees should be made aware about how tipping improves service and increases their income.

  5. Assesing the Impact of Local Incentives on Capital Cost: The Case of the Indiana Era Program

    Directory of Open Access Journals (Sweden)

    Esteban G. DALEHITE

    2006-02-01

    Full Text Available Public policy makers and administrators around the world recurrently face the question of whether to grant tax privileges to businesses in order to promote investment, jobs, or economic development in general. This article analyzes a very popular form of local incentive, the property tax abatement, and its ability to reduce capital cost. The research question is: By how much do property tax abatements reduce the capital cost of business and homes? Results show that abatements can account for quite a large range of possible percentage reductions in the price of investment for firms. The findings provide public administrators and policy makers with data and a tool to assess the benefits that firms derive from abatements. This in turn can contribute to more informed abatement decisions and to an overall assessment concerning the suitability of this tool to promote economic development.

  6. Land-use change and costs to rural households: a case study in groundwater nitrate contamination

    Science.gov (United States)

    Keeler, Bonnie L.; Polasky, Stephen

    2014-07-01

    Loss of grassland from conversion to agriculture threatens water quality and other valuable ecosystem services. Here we estimate how land-use change affects the probability of groundwater contamination by nitrate in private drinking water wells. We find that conversion of grassland to agriculture from 2007 to 2012 in Southeastern Minnesota is expected to increase the future number of wells exceeding 10 ppm nitrate-nitrogen by 45% (from 888 to 1292 wells). We link outputs of the groundwater well contamination model to cost estimates for well remediation, well replacement, and avoidance behaviors to estimate the potential economic value lost due to nitrate contamination from observed land-use change. We estimate 0.7-12 million in costs (present values over a 20 year horizon) to address the increased risk of nitrate contamination of private wells. Our study demonstrates how biophysical models and economic valuation can be integrated to estimate the welfare consequences of land-use change.

  7. Impact on cost accuracy and profitability from implementing product configuration system – A case-study

    DEFF Research Database (Denmark)

    Myrodia, Anna; Kristjansdottir, Katrin; Hvam, Lars

    2015-01-01

    This article aims at analyzing the impacts from implementing a product configuration system (PCS) on company profitability and improved cost estimations in the sales phase. Companies that have implemented PCSs have achieved substantial benefits in terms of being more in control of their product...... assortment, making the right decisions in the sales phase and increased sales of optimal products. Those benefits should have direct impact on improved profitability in terms of increased contribution ratios and more accurate cost estimations used to determine the price in the budgetary quotations....... As the literature describes, there are various benefits from implementing a PCS, however the effects on the company’s profitability have not been discussed in details. This study analyzes the impact from implementing a PCS on the accuracy of calculations in the quotations and the impact on the relative contribution...

  8. Cost of organic waste technologies: A case study for New Jersey

    Directory of Open Access Journals (Sweden)

    Gal Hochman

    2015-09-01

    Full Text Available This paper evaluates the benefits of converting food waste and manure to biogas and/or fertilizer, while focusing on four available waste treatment technologies: direct combustion, landfilling, composting, and anaerobic digestion. These four alternative technologies were simulated using municipal-level data on food waste and manure in New Jersey. The criteria used to assess the four technologies include technological productivity, economic benefits, and impact on land scarcity. Anaerobic digestion with gas collection has the highest technological productivity; using anaerobic digesters would supply electricity to nearly ten thousand families in New Jersey. In terms of economic benefits, the landfill to gas method is the least costly method of treating waste. In comparison, direct combustion is by far the most costly method of all four waste-to-energy technologies.

  9. Mobile teledermatopathology: using a tablet PC as a novel and cost-efficient method to remotely diagnose dermatopathology cases.

    Science.gov (United States)

    Speiser, Jodi J; Hughes, Ian; Mehta, Vikas; Wojcik, Eva M; Hutchens, Kelli A

    2014-01-01

    : Dermatopathology has relatively few studies regarding teledermatopathology and none have addressed the use of new technologies, such as the tablet PC. We hypothesized that the combination of our existing dynamic nonrobotic system with a tablet PC could provide a novel and cost-efficient method to remotely diagnose dermatopathology cases. 93 cases diagnosed by conventional light microscopy at least 5 months earlier by the participating dermatopathologist were retrieved by an electronic pathology database search. A high-resolution video camera (Nikon DS-L2, version 4.4) mounted on a microscope was used to transmit digital video of a slide to an Apple iPAD2 (Apple Inc, Cupertino, CA) at the pathologist's remote location via live streaming at an interval time of 500 ms and a resolution of 1280/960 pixels. Concordance to the original diagnosis and the seconds elapsed to reaching the diagnosis were recorded. 24.7% (23/93) of cases were melanocytic, 70.9% (66/93) were nonmelanocytic, and 4.4% (4/93) were inflammatory. About 92.5% (86/93) of cases were diagnosed on immediate viewing (<5 seconds), with the average time to diagnosis at 40.2 seconds (range: 10-218 seconds). Of the cases diagnosed immediately, 98.8% (85/86) of the telediagnoses were concordant with the original. Telepathology performed via a tablet PC may serve as a reliable and rapid technique for the diagnosis of routine cases with some diagnostic caveats in mind. Our study established a novel and cost-efficient solution for those institutions that may not have the capital to purchase either a dynamic robotic system or a virtual slide system.

  10. The Costs of Commonality: Examination of the JLTV as a Case Study

    Science.gov (United States)

    2016-07-15

    coordination among design, manufacturing, and marketing departments is critical to evaluating the profitability of common configurations and informing... trade analyses. Thus, they remain concealed in the defense acquisition process. Additionally, in order to capture these hidden costs, we propose a...the bottom line of profitability . In the initiation of a product line commonality strategy, either a zero-based approach (bottoms up) or a parts

  11. Inflation asymmetry, menu costs and aggregation bias – A further case for state dependent pricing

    OpenAIRE

    Karádi, Péter; Reiff, Ádám

    2010-01-01

    Asymmetric inflation response to aggregate shocks is an identifying macro-prediction of state dependent pricing models with trend inflation (Ball and Mankiw, 1994). The paper uses the natural experiment of symmetric value-added tax (VAT) changes in Hungary with highly asymmetric inflation responses to provide further evidence for state-dependent pricing and for the Ball-Mankiw conjecture. The paper shows, furthermore, that while a standard menu cost model like that of Golosov and Lucas (2007)...

  12. [High cost drugs for rare diseases in Brazil: the case of lysosomal storage disorders].

    Science.gov (United States)

    de Souza, Mônica Vinhas; Krug, Bárbara Corrêa; Picon, Paulo Dornelles; Schwartz, Ida Vanessa Doederlein

    2010-11-01

    This paper approaches in a critical way aspects of Brazilian public policies for drugs, emphasizing those classified as high cost and for rare diseases. The lysosomal storage diseases was taken as an example because of their rarity and the international trend for the development of new drugs for their treatment, all at high costs. Three lysosomal storage diseases were approached: Gaucher disease, Fabry disease and mucopolysaccharidosis type I. Gaucher disease has its treatment drug licensed in Brazil and guidelines for its use are established through a clinical protocol by the Ministry of Health. The others have their drug treatments registered in Brazil; however, no treatment guidelines for them have been developed by the government. The objective of the paper was to foster the discussion on the role of health technology assessment for high-cost drugs for rare diseases in Brazil, emphasizing the need for establishing health policies with legitimacy towards these diseases. Despite the difficulties in establishing a health policy for each rare disease, it is possible to create rational models to deal with this growing challenge.

  13. Wastewater treatment using low cost activated carbons derived from agricultural byproducts-A case study

    Energy Technology Data Exchange (ETDEWEB)

    Mohan, Dinesh [Environmental Chemistry Division, Industrial Toxicology Research Centre, Post Box No. 80, Mahatma Gandhi Marg, Lucknow 226001, U.P. (India)], E-mail: dm_1967@hotmail.com; Singh, Kunwar P.; Singh, Vinod K. [Environmental Chemistry Division, Industrial Toxicology Research Centre, Post Box No. 80, Mahatma Gandhi Marg, Lucknow 226001, U.P. (India)

    2008-04-15

    A variety of low cost activated carbons were developed from agricultural waste materials viz., coconut shell, coconut shell fibers and rice husk. The low cost activated carbons were fully characterized and utilized for the remediation of various pollutants viz., chemical oxygen demand (COD), heavy metals, anions, etc., from industrial wastewater. Sorption studies were carried out at different temperatures and particle sizes to study the effect of temperatures and surface areas. The removal of chloride and fluoride increased with rise in temperature while COD and metal ions removal decreased with increase in temperature, thereby, indicating the processes to be endothermic and exothermic, respectively. The kinetics of COD adsorption was also carried out at different temperatures to establish the sorption mechanism and to determine various kinetic parameters. The COD removal was 47-72% by coconut shell fiber carbon (ATFAC), 50-74% by coconut shell carbon (ATSAC) and 45-73% by rice husk carbon (ATRHC). Furthermore, COD removal kinetics by rice husk carbon, coconut shell carbon and coconut fiber carbon at different temperatures was approximately represented by a first order rate law. Results of this fundamental study demonstrate the effectiveness and feasibility of low cost activated carbons. The parameters obtained in this study can be fully utilized to establish fixed bed reactors on large scale to treat the contaminated water.

  14. Assessing Sustainability of Mixed Use Neighbourhoods through Residents’ Travel Behaviour and Perception: The Case of Nagpur, India

    Directory of Open Access Journals (Sweden)

    Sarika Bahadure

    2015-09-01

    Full Text Available Mixed land-use development is the integration of different land-use functions like residential, commercial, recreational, and institutional in an urban sector or a neighbourhood. Integrating transport and land-use mix is one of the goals of planning policies around the world. Prior studies mention the benefits of mixed land-use development towards creating sustainable environment, but do not specify the proportion of the mix of compatible land uses. This study attempts to assess the sustainability of the neighbourhoods with mixed land-use in the context of the Nagpur city, India. Residents’ travel behaviour in twelve neighbourhoods is studied by means of indicators namely trip lengths, mode of travel, vehicle ownership, and travel expenses. To investigate the users’ insight, the study further examines residents’ perception with the help of parameters such as safety, satisfaction, pollution, and mix. The sustainability indices are computed for both residents’ travel behaviour and perception, for each neighbourhood. The study revealed that neighbourhoods with high and moderate land-use mix are sustainable with travel behaviour. Residents’ perception sustainability index indicates neighbourhoods with moderate land-use mix are more sustainable than those with high and low land-use mixed neighbourhoods. This study advocates stakeholders’ insight and the proportion of mix in land-use planning decisions.

  15. Mixed methods evaluation of targeted case finding for cardiovascular disease prevention using a stepped wedged cluster RCT

    Directory of Open Access Journals (Sweden)

    Marshall Tom

    2012-10-01

    Full Text Available Abstract Background A pilot project cardiovascular prevention was implemented in Sandwell (West Midlands, UK. This used electronic primary care records to identify untreated patients at high risk of cardiovascular disease then invited these high risk patients for assessment by a nurse in their own general practice. Those found to be eligible for treatment were offered treatment. During the pilot a higher proportion of high risk patients were started on treatment in the intervention practices than in control practices. Following the apparent success of the prevention project, it was intended to extend the service to all practices across the Sandwell area. However the pilot project was not a robust evaluation. There was a need for an efficient evaluation that would not disrupt the planned rollout of the project. Methods/design Project nurses will sequentially implement targeted cardiovascular case finding in a phased way across all general practices, with the sequence of general practices determined randomly. This is a stepped wedge randomised controlled trial design. The target population is patients aged 35 to 74, without diabetes or cardiovascular disease whose ten-year cardiovascular risk, (determined from data in their electronic records is ≥20%. The primary outcome is the number of high risk patients started on treatment, because these data could be efficiently obtained from electronic primary care records. From this we can determine the effects of the case finding programme on the proportion of high risk patients started on treatment in practices before and after implementation of targeted case finding. Cost-effectiveness will be modelled from the predicted effects of treatments on cardiovascular events and associated health service costs. Alongside the implementation it is intended to interview clinical staff and patients who participated in the programme in order to determine acceptability to patients and clinicians. Practical

  16. To a cultural perspective of mixed reality events: a case study of event overflow in operas and concerts in mixed reality

    Science.gov (United States)

    Lucas, Jean-François; Cornish, Tracy; Margolis, Todd

    2012-12-01

    Mixed reality defines the sharing of a space-time between the real and the virtual world. The definition of this concept is further extended when virtual worlds such as Second Life® (SL) are included. Through cultural events such as concerts and operas, we will see that the main goal of these kinds of projects is not simply to offer a video and audio broadcast of these events in the digital dimension. The current challenge is to create interactions between the individuals who are in different shared spaces. By studying the unfolding of these events in its various phases-before, during, and after-we examine the culture of the event. We question how the culture of the event can be transposed in a mixed reality display, and how this kind of event can affect people on both sides of the "membrane" made by the technical configuration. Beyond the alignments and adjustments that we can see between the different individuals involved in these events, we examine more broadly the changes and mutations of the culture of the event in this specific configuration.

  17. Airlines Performance and Eflciency Evaluation using a MCDA Methodology. The Case for Low Cost Carriers vs Legacy Carriers

    Science.gov (United States)

    Miranda, Miguel; Baltazar, Maria E.; Silva, Jorge

    2016-11-01

    The air transport has suffered a remarkable transformation over the past decade. Thewaywe travel today is quite different from how we did ten years ago. Due to the rise of low cost carriers, the market of air transportation has been constantly changing and presently witnessing the transformation of legacy carriers in order to manage to continue operating. The main purpose of thiswork is to show the differences in efficiency for different performance areas on a case study comprised of six different airline carriers, legacy and low cost, using a Multi Criteria Decision Making (MCDA) tool - Measuring Attractiveness by a Category Based Evaluation Technique (MACBETH). With the results obtained in this study, it is expected to show the work that is being carried out to obtain a model that would measure the efficiency of one or various airline companies in a defined period of time, using a set of performance indicators, to which specialists in the area previously have given weights.

  18. Impact of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine use in wound management on health care costs and pertussis cases.

    Science.gov (United States)

    Talbird, Sandra E; Graham, Jonathan; Mauskopf, Josephine; Masseria, Cristina; Krishnarajah, Girishanthy

    2015-01-01

    The Advisory Committee on Immunization Practices (ACIP) recommends the use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine for routine wound management in adolescents and adults who require a tetanus toxoid-containing vaccine who were vaccinated ≥ 5 years earlier with tetanus toxoid, reduced diphtheria toxoid (Td) vaccine, and who have not previously received Tdap. To estimate the overall budget and health impact of vaccinating individuals presenting for wound management with Tdap instead of Td vaccine, the current standard of care in practices that do not use Tdap for purposes of wound management. A decision-analytic economic model was developed to estimate the expected increase in direct medical costs and the expected number of cases of pertussis avoided associated with the use of Tdap instead of Td vaccine in the wound management setting. Patients eligible for Tdap were aged 10+ years and required a tetanus-containing vaccine. Age-specific wound incidence data and Td and Tdap vaccination rates were taken from the National Health Interview Survey and the National Immunization Survey for the most recent available year. Age-specific pertussis incidence used in this analysis (151 per 100,000 for adolescents, 366 per 100,000 for those aged 20-64 years, and 176 per 100,000 for those aged 65+ years) used reported incidence rates adjusted by a factor of 10 for adolescents and by a factor of 100 for adults, based on assumptions previously made by ACIP to account for underreporting. Vaccine wholesale acquisition costs without federal excise tax were assumed in the base case. Efficacy of vaccination with Tdap in preventing pertussis was based on clinical trial data. Possible herd immunity effects of vaccination were not included in the model. Costs associated with vaccination and treatment of pertussis cases were reported as total annual costs and per-member-per-month (PMPM) costs for hypothetical health plans and for the U

  19. Using public control genotype data to increase power and decrease cost of case-control genetic association studies.

    Science.gov (United States)

    Ho, Lindsey A; Lange, Ethan M

    2010-12-01

    Genome-wide association (GWA) studies are a powerful approach for identifying novel genetic risk factors associated with human disease. A GWA study typically requires the inclusion of thousands of samples to have sufficient statistical power to detect single nucleotide polymorphisms that are associated with only modest increases in risk of disease given the heavy burden of a multiple test correction that is necessary to maintain valid statistical tests. Low statistical power and the high financial cost of performing a GWA study remains prohibitive for many scientific investigators anxious to perform such a study using their own samples. A number of remedies have been suggested to increase statistical power and decrease cost, including the utilization of free publicly available genotype data and multi-stage genotyping designs. Herein, we compare the statistical power and relative costs of alternative association study designs that use cases and screened controls to study designs that are based only on, or additionally include, free public control genotype data. We describe a novel replication-based two-stage study design, which uses free public control genotype data in the first stage and follow-up genotype data on case-matched controls in the second stage that preserves many of the advantages inherent when using only an epidemiologically matched set of controls. Specifically, we show that our proposed two-stage design can substantially increase statistical power and decrease cost of performing a GWA study while controlling the type-I error rate that can be inflated when using public controls due to differences in ancestry and batch genotype effects.

  20. [An analysis of cost and profit of a nursing unit using performance-based costing: case of a general surgical ward in a general hospital].

    Science.gov (United States)

    Lim, Ji Young

    2008-02-01

    The aim of this study was to analyze net income of a surgical nursing ward in a general hospital. Data collection and analysis was conducted using a performance-based costing and activity-based costing method. Direct nursing activities in the surgical ward were 68, indirect nursing activities were 10. The total cost volume of the surgical ward was calculated at won 119,913,334.5. The cost volume of the allocated medical department was won 91,588,200.3, and the ward consumed cost was won 28,325,134.2. The revenue of the surgical nursing ward was won 33,269,925.0. The expense of a surgical nursing ward was 28,325,134.2. Therefore, the net income of a surgical nursing ward was won 4,944,790.8. We suggest that to develop a more refined nursing cost calculation model, a standard nursing cost calculation system needs to be developed.