WorldWideScience

Sample records for cost effective recovery

  1. The effect of short recovery period investment on least-cost generation system expansion

    International Nuclear Information System (INIS)

    Yiqun He; David, A.K.; Fernando, P.N.

    1995-01-01

    The effect of the short recovery period of private investment on least-cost generation system expansion is analysed, and a trade-off method for generation system expansion, which gives consideration to both the least-cost strategy and the short recovery period of private investment, is presented. First, the optimal mix of generation units under a standard recovery period for all units is established, and then the surcharge, due to the difference between the short recovery period and the standard recovery period, is calculated and shared between all units. The former is an optimization to make best use of natural resources, and the latter is a trade-off method to spread the surcharge throughout the system. (Author)

  2. Cost Recovery Through Depreciation.

    Science.gov (United States)

    Forrester, Robert T.; Wesolowski, Leonard V.

    1983-01-01

    The approach of adopting depreciation rather than use allowance in order to recover more accurately the cost of college buildings and equipment used on federal projects is considered. It is suggested that depreciation will offer most colleges and universities a higher annual recovery rate, and an opportunity for better facilities planning. For…

  3. Cost-effectiveness of enhanced recovery in hip and knee replacement: a systematic review protocol.

    Science.gov (United States)

    Murphy, Jacqueline; Pritchard, Mark G; Cheng, Lok Yin; Janarthanan, Roshni; Leal, José

    2018-03-14

    Hip and knee replacement represents a significant burden to the UK healthcare system. 'Enhanced recovery' pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways. A systematic review will be conducted using MEDLINE, EMBASE, Econlit and the National Health Service Economic Evaluations Database. Separate search strategies were developed for each database including terms relating to hip and knee replacement/arthroplasty, economic evaluations, decision modelling and quality of life measures.We will extract peer-reviewed studies published between 2000 and 2017 reporting economic evaluations of preoperative, perioperative or postoperative enhanced recovery interventions within hip or knee replacement. Economic evaluations alongside cohort studies or based on decision models will be included. Only studies with patients undergoing elective replacement surgery of the hip or knee will be included. Data will be extracted using a predefined pro forma following best practice guidelines for economic evaluation, decision modelling and model validation.Our primary outcome will be the cost-effectiveness of enhanced recovery (entire pathway and individual components) in terms of incremental cost per quality-adjusted life year. A narrative synthesis of all studies will be presented, focussing on cost-effectiveness results, study design, quality and validation status. This systematic review is exempted from ethics approval because the work is carried out on published documents. The results of the review will be

  4. Cost Effective Recovery of Low-TDS Frac Flowback Water for Re-use

    Energy Technology Data Exchange (ETDEWEB)

    Claire Henderson; Harish Acharya; Hope Matis; Hareesh Kommepalli; Brian Moore; Hua Wang

    2011-03-31

    The project goal was to develop a cost-effective water recovery process to reduce the costs and envi-ronmental impact of shale gas production. This effort sought to develop both a flowback water pre-treatment process and a membrane-based partial demineralization process for the treatment of the low-Total Dissolved Solids (TDS) portion of the flowback water produced during hydrofracturing operations. The TDS cutoff for consideration in this project is < 35,000 {approx} 45,000 ppm, which is the typical limit for economic water recovery employing reverse osmosis (RO) type membrane desalination processes. The ultimate objective is the production of clean, reclaimed water suitable for re-use in hydrofracturing operations. The team successfully compiled data on flowback composition and other attributes across multiple shale plays, identified the likely applicability of membrane treatment processes in those shales, and expanded the proposed product portfolio to include four options suitable for various reuse or discharge applications. Pretreatment technologies were evaluated at the lab scale and down-selected based upon their efficacy in removing key contaminants. The chosen technologies were further validated by performing membrane fouling studies with treated flowback water to demonstrate the technical feasibility of flowback treatment with RO membranes. Process flow schemes were constructed for each of the four product options based on experimental performance data from actual flowback water treatment studies. For the products requiring membrane treatment, membrane system model-ing software was used to create designs for enhanced water recovery beyond the typical seawater desalination benchmark. System costs based upon vendor and internal cost information for all process flow schemes were generated and are below target and in line with customer expectations. Finally, to account for temporal and geographic variability in flowback characteristics as well as local

  5. Cost-effective treatment of swine wastes through recovery of energy and nutrients.

    Science.gov (United States)

    Amini, Adib; Aponte-Morales, Veronica; Wang, Meng; Dilbeck, Merrill; Lahav, Ori; Zhang, Qiong; Cunningham, Jeffrey A; Ergas, Sarina J

    2017-11-01

    Wastes from concentrated animal feeding operations (CAFOs) are challenging to treat because they are high in organic matter and nutrients. Conventional swine waste treatment options in the U.S., such as uncovered anaerobic lagoons, result in poor effluent quality and greenhouse gas emissions, and implementation of advanced treatment introduces high costs. Therefore, the purpose of this paper is to evaluate the performance and life cycle costs of an alternative system for treating swine CAFO waste, which recovers valuable energy (as biogas) and nutrients (N, P, K + ) as saleable fertilizers. The system uses in-vessel anaerobic digestion (AD) for methane production and solids stabilization, followed by struvite precipitation and ion exchange (IX) onto natural zeolites (chabazite or clinoptilolite) for nutrient recovery. An alternative approach that integrated struvite recovery and IX into a single reactor, termed STRIEX, was also investigated. Pilot- and bench-scale reactor experiments were used to evaluate the performance of each stage in the treatment train. Data from these studies were integrated into a life cycle cost analysis (LCCA) to assess the cost-effectiveness of various process alternatives. Significant improvement in water quality, high methane production, and high nutrient recovery (generally over 90%) were observed with both the AD-struvite-IX process and the AD-STRIEX process. The LCCA showed that the STRIEX system can provide considerable financial savings compared to conventional systems. AD, however, incurs high capital costs compared to conventional anaerobic lagoons and may require larger scales to become financially attractive. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Cost Effective Surfactant Formulations for Improved Oil Recovery in Carbonate Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    William A. Goddard; Yongchun Tang; Patrick Shuler; Mario Blanco; Yongfu Wu

    2007-09-30

    This report summarizes work during the 30 month time period of this project. This was planned originally for 3-years duration, but due to its financial limitations, DOE halted funding after 2 years. The California Institute of Technology continued working on this project for an additional 6 months based on a no-cost extension granted by DOE. The objective of this project is to improve the performance of aqueous phase formulations that are designed to increase oil recovery from fractured, oil-wet carbonate reservoir rock. This process works by increasing the rate and extent of aqueous phase imbibition into the matrix blocks in the reservoir and thereby displacing crude oil normally not recovered in a conventional waterflood operation. The project had three major components: (1) developing methods for the rapid screening of surfactant formulations towards identifying candidates suitable for more detailed evaluation, (2) more fundamental studies to relate the chemical structure of acid components of an oil and surfactants in aqueous solution as relates to their tendency to wet a carbonate surface by oil or water, and (3) a more applied study where aqueous solutions of different commercial surfactants are examined for their ability to recover a West Texas crude oil from a limestone core via an imbibition process. The first item, regarding rapid screening methods for suitable surfactants has been summarized as a Topical Report. One promising surfactant screening protocol is based on the ability of a surfactant solution to remove aged crude oil that coats a clear calcite crystal (Iceland Spar). Good surfactant candidate solutions remove the most oil the quickest from the surface of these chips, plus change the apparent contact angle of the remaining oil droplets on the surface that thereby indicate increased water-wetting. The other fast surfactant screening method is based on the flotation behavior of powdered calcite in water. In this test protocol, first the calcite

  7. AECB Cost Recovery Fees Regulations, amendment

    International Nuclear Information System (INIS)

    1992-01-01

    The amendments to the AECB Cost Recovery Fees Regulations have been made with a view to simplifying the registration procedure for obtaining such a certificate or approval under the above Transport Regulations. In effect there will no longer be a need for a separate fee system for registered users of certified package designs. (NEA)

  8. 50 CFR 680.44 - Cost recovery.

    Science.gov (United States)

    2010-10-01

    ...) Publication—(i) General. During the first quarter of each crab fishing year, NMFS shall calculate the crab fee... Management Measures § 680.44 Cost recovery. (a) Cost recovery fees—(1) Responsibility. The person documented... holder's liability for noncompliance with this section. (2) Fee liability determination. (i) All CR...

  9. Advanced Membrane Filtration Technology for Cost Effective Recovery of Fresh Water from Oil & Gas Produced Brine

    Energy Technology Data Exchange (ETDEWEB)

    David B. Burnett

    2004-09-29

    Produced water is a major waste generated at the oil and natural gas wells in the state of Texas. This water could be a possible source of new fresh water to meet the growing demands of the state after treatment and purification. Treatment of brine generated in oil fields or produced water with an ultrafiltration membranes were the subject of this thesis. The characterization of ultrafiltration membranes for oil and suspended solids removal of produced water, coupled with the reverse osmosis (RO) desalination of brine were studied on lab size membrane testing equipment and a field size testing unit to test whether a viable membrane system could be used to treat produced water. Oil and suspended solids were evaluated using turbidity and oil in water measurements taken periodically. The research considered the effect of pressure and flow rate on membrane performance of produced water treatment of three commercially available membranes for oily water. The study also analyzed the flux through the membrane and any effect it had on membrane performance. The research showed that an ultrafiltration membrane provided turbidity removal of over 99% and oil removal of 78% for the produced water samples. The results indicated that the ultrafiltration membranes would be asset as one of the first steps in purifying the water. Further results on selected RO membranes showed that salt rejection of greater than 97% could be achieved with satisfactory flux and at reasonable operating cost.

  10. Effect of a low-cost food on the recovery and death rate of malnourished children.

    Science.gov (United States)

    Greco, Luigi; Balungi, Jacquie; Amono, Kevin; Iriso, Robert; Corrado, Bruno

    2006-10-01

    Nutritional rehabilitation in Africa relies mainly on imported skim milk enriched with a sugar and salt mixture. We evaluated whether milk plus porridge made from local ingredients improves the outcome of childhood nutritional rehabilitation versus milk alone. This study was conducted in a nutritional unit in Lacor (Northern Uganda). The porridge, made from cheap locally available ingredients (maize flour, dried fish or meat, peanut butter and oil) supplemented with proteins and fats, provides 1.1 energy units, 4.4 kJ/g. We randomly sampled the files of 100 cases discharged in October, November and December 2001 (preintervention), in 2002 (soon after intervention onset) and in 2003 (more than 1 year after intervention onset). We recorded the average hospital days and average oedema-free weight gain at discharge in the 3 groups. Average oedema-free weight gain increased from 21 g/d (95% confidence interval [CI], 12-29) in 2001 to 35 g/d (95% CI, 25-45) in 2002 and reached 59 g/d (95% CI, 51-65) in 2003. Mortality decreased from 22% to 7.8%, and nutritional failures (insufficient weight gain) decreased by greater than 50%. The low-cost porridge supplement (2640 euros/yr per 100 children) was effective in treating malnutrition. Widespread use of the porridge, which resulted in better outcomes than milk alone, could produce a savings in the medium- to long-term, thereby releasing resources for other uses. A high-energy porridge that is made from locally available ingredients and does not require imported foods seems to be appropriate for supplementary feeding after mother's milk in this setting.

  11. Universal access, cost recovery, and payment services

    OpenAIRE

    Sujit Chakravorti; Jeffery W. Gunther; Robert R. Moore

    2005-01-01

    We suggest a subtle, yet far- reaching, tension in the objectives specified by the Monetary Control Act of 1980 (MCA) for the Federal Reserve’s role in providing retail payment services, such as check processing. Specifically, we argue that the requirement of an overall cost-revenue match, coupled with the goal of ensuring equitable access on a universal basis, partially shifted the burden of cost recovery from high-cost to low-cost service points during the MCA’s early years, thereby allowin...

  12. AECB Cost Recovery Fees Regulations, amendment

    International Nuclear Information System (INIS)

    1991-01-01

    The amendment to the Regulations was published on 24 October 1991 (SOR/91-590,Canada Gazette Part II, Vol.125, No 23). It modifies the list of institutions exempted from paying cost recovery fees (licence fees) to the Atomic Energy Control Board. The exemptions now include educational and health care institutions as well as Departments. (NEA)

  13. The economic effect of electricity net-metering with solar PV: Consequences for network cost recovery, cross subsidies and policy objectives

    International Nuclear Information System (INIS)

    Eid, Cherrelle; Reneses Guillén, Javier; Frías Marín, Pablo; Hakvoort, Rudi

    2014-01-01

    Net-metering is commonly known as a practice by which owners of distributed generation (DG) units may offset their electricity consumption from the grid with local generation. The increasing number of prosumers (consumers that both produce and consume electricity) with solar photovoltaic (PV) generation combined with net-metering results in reduced incomes for many network utilities worldwide. Consequently, this pushes utilities to increase charges per kW h in order to recover costs. For non-PV owners, this could result into inequality issues due to the fact that also non-PV owners have to pay higher chargers for their electricity consumed to make up for netted costs of PV-owners. In order to provide insight in those inequality issues caused by net-metering, this study presents the effects on cross-subsidies, cost recovery and policy objectives evolving from different applied netmetering and tariff designs for a residential consumer. Eventually this paper provides recommendations regarding tariffs and metering that will result in more explicit incentives for PV, instead of the current implicit incentives which are present to PV owners due to net-metering. - Highlights: • Network users are frequently charged by energy charging and fixed charging. • Net-metering with energy charging causes potential problems for DSO cost recovery. • Increasing rolling credit timeframes amplify net-metering impacts on cost recovery. • Observed capacity charging can incentivize local storage and self-consumption. • PV owners should receive direct incentives in order to avoid cross subsidization

  14. The evolving regulation of uranium recovery operations in the United States: Inovative approaches are necessary for cost effective regulatory oversight

    International Nuclear Information System (INIS)

    Thompson, A.J.; Lehrenbaum, W.U.; Lashway, D.C.

    2000-01-01

    The US domestic uranium industry is at a crossroads. Historic low prices for uranium, combined with stringent and often irrational regulatory requirements, pose a very real threat to the industry's continued viability. The Nuclear Regulatory Commission has taken a number of innovative steps to reform and rationalize its regulatory program. However, if the domestic uranium recovery industry is to remain viable, additional steps toward innovation and reform are needed, and effective implementation of reforms adopted by the Commission is essential. (author)

  15. Stranded cost recovery in electricity market reforms in the US

    International Nuclear Information System (INIS)

    Woo, C.K.; Lloyd, D.; Karimov, R.; Tishler, A.

    2003-01-01

    An important element of an electricity market reform is stranded cost recovery. This paper explains the cause of stranded costs, describes four recovery mechanisms, evaluates these mechanisms using the criteria of recovery certainty, economic efficiency and equity, reviews the financial performance of 12 utilities in the US in connection to stranded cost recovery, and shows why the mechanism used in California has contributed to the reform failure in that state. (Author)

  16. Modeling economic costs of disasters and recovery involving positive effects of reconstruction: analysis using a dynamic CGE model

    Science.gov (United States)

    Xie, W.; Li, N.; Wu, J.-D.; Hao, X.-L.

    2013-11-01

    Disaster damages have negative effects on economy, whereas reconstruction investments have positive effects. The aim of this study is to model economic causes of disasters and recovery involving positive effects of reconstruction activities. Computable general equilibrium (CGE) model is a promising approach because it can incorporate these two kinds of shocks into a unified framework and further avoid double-counting problem. In order to factor both shocks in CGE model, direct loss is set as the amount of capital stock reduced on supply side of economy; A portion of investments restore the capital stock in existing period; An investment-driven dynamic model is formulated due to available reconstruction data, and the rest of a given country's saving is set as an endogenous variable. The 2008 Wenchuan Earthquake is selected as a case study to illustrate the model, and three scenarios are constructed: S0 (no disaster occurs), S1 (disaster occurs with reconstruction investment) and S2 (disaster occurs without reconstruction investment). S0 is taken as business as usual, and the differences between S1 and S0 and that between S2 and S0 can be interpreted as economic losses including reconstruction and excluding reconstruction respectively. The study showed that output from S1 is found to be closer to real data than that from S2. S2 overestimates economic loss by roughly two times that under S1. The gap in economic aggregate between S1 and S0 is reduced to 3% in 2011, a level that should take another four years to achieve under S2.

  17. Medical Care Cost Recovery National Database (MCCR NDB)

    Data.gov (United States)

    Department of Veterans Affairs — The Medical Care Cost Recovery National Database (MCCR NDB) provides a repository of summary Medical Care Collections Fund (MCCF) billing and collection information...

  18. Earthquake recovery of historic buildings: exploring cost and time needs.

    Science.gov (United States)

    Al-Nammari, Fatima M; Lindell, Michael K

    2009-07-01

    Disaster recovery of historic buildings has rarely been investigated even though the available literature indicates that they face special challenges. This study examines buildings' recovery time and cost to determine whether their functions (that is, their use) and their status (historic or non-historic) affect these outcomes. The study uses data from the city of San Francisco after the 1989 Loma Prieta earthquake to examine the recovery of historic buildings owned by public agencies and non-governmental organisations. The results show that recovery cost is affected by damage level, construction type and historic status, whereas recovery time is affected by the same variables and also by building function. The study points to the importance of pre-incident recovery planning, especially for building functions that have shown delayed recovery. Also, the study calls attention to the importance of further investigations into the challenges facing historic building recovery.

  19. 75 FR 16575 - Railroad Cost Recovery Procedures-Productivity Adjustment

    Science.gov (United States)

    2010-04-01

    ...)] Railroad Cost Recovery Procedures--Productivity Adjustment AGENCY: Surface Transportation Board. ACTION: Adoption of a railroad cost recovery procedures productivity adjustment. SUMMARY: By decision served on February 1, 2010, the Board proposed to adopt 1.010 (1.0% per year) as the 2008 productivity adjustment, as...

  20. 75 FR 5170 - Railroad Cost Recovery Procedures-Productivity Adjustment

    Science.gov (United States)

    2010-02-01

    ...)] Railroad Cost Recovery Procedures--Productivity Adjustment AGENCY: Surface Transportation Board, DOT. ACTION: Proposed Railroad Cost Recovery Procedures Productivity Adjustment. SUMMARY: In a decision served... railroad productivity for the 2004-2008 (5-year) averaging period. This is a decline of 0.5 of a percentage...

  1. 77 FR 7237 - Railroad Cost Recovery Procedures-Productivity Adjustment

    Science.gov (United States)

    2012-02-10

    ... Cost Recovery Procedures--Productivity Adjustment AGENCY: Surface Transportation Board. ACTION: Proposed railroad cost recovery procedures productivity adjustment. SUMMARY: In a decision served on... productivity for the 2006-2010 (5-year) averaging period. This represents a 0.6% decrease over the average for...

  2. 78 FR 10262 - Railroad Cost Recovery Procedures-Productivity Adjustment

    Science.gov (United States)

    2013-02-13

    ... Cost Recovery Procedures--Productivity Adjustment AGENCY: Surface Transportation Board, DOT. ACTION: Proposed railroad cost recovery procedures productivity adjustment. SUMMARY: In a decision served on... productivity for the 2007-2011 (5-year) averaging period. This represents a 0.1% increase over the average for...

  3. Lowering operation costs by energy recovery

    Energy Technology Data Exchange (ETDEWEB)

    Wegener, W; Hausmann, H; Hausmann, K H

    1976-01-01

    Heat recovery and the heat sources available as well as possible applications of the heat recovered are discussed. Groundwater, shower water and waste air are considered as energy sources. Energy recovery by means of finned-tube systems and the heat pump, and economic aspects of the techniques are described.

  4. Study on the feasibility of implementing a cost-recovery program

    International Nuclear Information System (INIS)

    1988-02-01

    The AECB does not currently have an adequate legal basis for cost recovery. The use of amendments to the AEC (Atomic Energy Control) Act or Regulations to effect cost recovery would entail too high a risk of successful legal challenge and political complications which could adversely affect the AECB's operational effectiveness. In the time frame envisaged by Treasury Board Secretariat for the AECB to collect fees, it is not practical to amend the AEC Act to make it binding on the Crown, and specifically to authorize the AECB to recover its costs. The only practical approach to providing a sound legal basis for cost recovery is through amendment of the Financial Administration Act. Studies to date have provided a basis to establish options for cost recovery which may be practical, provided that a sound legal basis is established. Studies to date have not provided a basis to evaluate the impact of any of these options on the development, application, and use of atomic energy in Canada, or on the regulatory effectiveness of the AECB. While the principle of cost-recovery has been decided by the Treasury Board, public consultations are needed to evaluate impact and to arrive at a final decision on the extent of cost recovery. Such consultations are required by the government's Regulatory Process Action Plan. Cost recovery is likely to generate a strong negative reaction from the nuclear industry, some of which may affect the ability of the AECB to implement an effective regulatory program

  5. Nitrous Oxide and Nitrous Oxide-Free Low-Flow Anesthesia Using Bispectral Index Monitoring: Effects on Hemodynamics, Recovery Times, Volatile Anesthetic Consumption and Costs

    Directory of Open Access Journals (Sweden)

    Bengü Gülhan Köksal

    2010-12-01

    Full Text Available Aim: In this study, we aimed to compare the effects of desfluraneN2O and desflurane-fentanyl combinations on hemodynamics, recovery times, volatile anesthetic consumption and costs in low-flow desflurane anesthesia by bispectral index (BIS monitoring of depth of anesthesia. Methods: After approval of ethics committee and obtaining patient consents, 60 patients were divided into two equal groups randomly. Non-invasive blood pressure measurement, ECG, SpO2 and BIS were monitored. All patients received 10 L .min-1 100% oxygen with mask for 5 minute before intubation. 2 mg.kg-1 propofol, 2 μg.kg-1 fentanyl and 0.6 mg.kg-1 rocuronium bromide were administered at induction in both groups. Desfluran 6% was chosen for anesthesia maintenance. Group 1 received 50% O2-N2O mixture in 6 L.min-1 and Group 2 received 50% O2-air mixture in 6 L.min-1 as carrier gas. Low-flow anesthesia (1 L.min-1 was started after a 10-min period of initial high flow (6 L.min-1. In Group 2, infusion of fentanyl was begun in 1 μg.kg.hour-1 rate. Desflurane level was adjusted at a main BIS value of 40-60. Blood pressure, heart rate, FiO2, etO2, FiN22, EtN2O, FiCO2, EtCO2, Fidesfluran and Etdesflurane were recorded. Results: There were no significant differences between the two groups in terms of heart rate, arterial blood pressure, settings of desfluran and recovery time. BIS values (p<0.001 and anesthetic agent costs (p<0.001 were higher in Group 2. Conclusion: Using fentanyl infusion instead of nitrous oxide in low flow-anesthesia with desflurane did not alter the hemodynamic parameters. Fentanyl infusion with medical air-oxygen as carrier gas is an alternative technique, but increases BIS values and anesthetic agent costs. (The Medical Bulletin of Haseki 2010; 48: 132-8

  6. 18 CFR 284.265 - Cost recovery by interstate pipeline.

    Science.gov (United States)

    2010-04-01

    ... 1978 AND RELATED AUTHORITIES Emergency Natural Gas Sale, Transportation, and Exchange Transactions... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Cost recovery by interstate pipeline. 284.265 Section 284.265 Conservation of Power and Water Resources FEDERAL ENERGY...

  7. An Insight Into Budgeting, The Funding And Cost Recovery of ...

    African Journals Online (AJOL)

    The study further revealed that Institutions' financial support for students was woefully inadequate. Students' fee payment was also identified as the main modality for cost recovery of tertiary education. It was recommended that communities and industries should be made to make meaningful contributions towards tertiary ...

  8. The Societal Benefits and Costs of School Dropout Recovery

    Directory of Open Access Journals (Sweden)

    James S. Catterall

    2011-01-01

    Full Text Available This article reports an analysis of the societal benefits and costs of recovering school dropouts. Successful recovery is defined by subsequent graduation from high school. The analysis is based on established estimates of the societal costs of dropping out including reduced government tax collections and higher social costs of welfare, healthcare, and crime. These potential costs are cast as benefits when a dropout is recovered. A large dropout recovery program provides the setting for the analysis. Rigorous attention is given to accurate estimation of the number of students who would not have graduated without the program in the year assessed and to the induced public costs of their continued education. Estimated benefits are weighed against the total annual public costs of the program, which operates in 65 school centers and commands an annual budget of about $70 million. The estimated benefit-cost ratio for this program is 3 to 1, a figure comparable to benefit-cost ratio estimates reported in studies of dropout prevention. The sensitivity of this conclusion to specific assumptions within the analysis is discussed.

  9. The evolving regulation of uranium recovery operations in the United States of America: Innovative approaches are necessary for cost effective regulatory oversight

    International Nuclear Information System (INIS)

    Thompson, A.J.; Lehrenbaum, W.U.; Lashway, D.C.

    2002-01-01

    The US domestic uranium industry is at a crossroads. Historic low prices for uranium, combined with stringent and often irrational regulatory requirements, pose a very real threat to the industry's continued viability. The Nuclear Regulatory Commission has taken a number of innovative steps to reform and rationalize its regulatory programme. However, if the domestic uranium recovery industry is to remain viable, additional steps toward innovation and reform are needed, and effective implementation of reforms adopted by the Commission is essential. (author)

  10. The long-term power purchase: Recovery of capacity costs

    International Nuclear Information System (INIS)

    Cross, P.S.

    1990-01-01

    As electric utilities increase their reliance on the long-term power purchase as an alternative to utility-owned generation, the appropriate rate treatment of the costs established in the purchase agreement assumes growing importance. In the November 9, 1989, issue, the authors examined the recent trend among state regulators to treat the long-term purchase in a manner similar to the addition by a utility of a new plant, including a full-scale prudence review. This installment will review recent rulings on the related issue of rate recovery of long-term capacity costs through the fuel cost adjustment clause

  11. Cost Scaling of a Real-World Exhaust Waste Heat Recovery Thermoelectric Generator: A Deeper Dive

    Science.gov (United States)

    Hendricks, Terry J.; Yee, Shannon; LeBlanc, Saniya

    2015-01-01

    Cost is equally important to power density or efficiency for the adoption of waste heat recovery thermoelectric generators (TEG) in many transportation and industrial energy recovery applications. In many cases the system design that minimizes cost (e.g., the $/W value) can be very different than the design that maximizes the system's efficiency or power density, and it is important to understand the relationship between those designs to optimize TEG performance-cost compromises. Expanding on recent cost analysis work and using more detailed system modeling, an enhanced cost scaling analysis of a waste heat recovery thermoelectric generator with more detailed, coupled treatment of the heat exchangers has been performed. In this analysis, the effect of the heat lost to the environment and updated relationships between the hot-side and cold-side conductances that maximize power output are considered. This coupled thermal and thermoelectric treatment of the exhaust waste heat recovery thermoelectric generator yields modified cost scaling and design optimization equations, which are now strongly dependent on the heat leakage fraction, exhaust mass flow rate, and heat exchanger effectiveness. This work shows that heat exchanger costs most often dominate the overall TE system costs, that it is extremely difficult to escape this regime, and in order to achieve TE system costs of $1/W it is necessary to achieve heat exchanger costs of $1/(W/K). Minimum TE system costs per watt generally coincide with maximum power points, but Preferred TE Design Regimes are identified where there is little cost penalty for moving into regions of higher efficiency and slightly lower power outputs. These regimes are closely tied to previously-identified low cost design regimes. This work shows that the optimum fill factor Fopt minimizing system costs decreases as heat losses increase, and increases as exhaust mass flow rate and heat exchanger effectiveness increase. These findings have

  12. Claus sulphur recovery potential approaches 99% while minimizing cost

    Energy Technology Data Exchange (ETDEWEB)

    Berlie, E M

    1974-01-21

    In a summary of a paper presented to the fourth joint engineering conference of the American Institute of Chemical Engineers and the Canadian Society for Chemical Engineering, the Claus process is discussed in a modern setting. Some problems faced in the operation of sulfur recovery plants include (1) strict pollution control regulations; (2) design and operation of existing plants; (3) knowledge of process fundamentals; (4) performance testing; (5) specification of feed gas; (6) catalyst life; (7) instrumentation and process control; and (8) quality of feed gas. Some of the factors which must be considered in order to achieve the ultimate capability of the Claus process are listed. There is strong evidence to support the contention that plant operators are reluctant to accept new fundamental knowledge of the Claus sulfur recovery process and are not taking advantage of its inherent potential to achieve the emission standards required, to minimize cost of tail gas cleanup systems and to minimize operating costs.

  13. Transaction Costs in Collective Waste Recovery Systems in the EU

    OpenAIRE

    Nozharov, Shteryo

    2018-01-01

    The study aims to identify the institutional flaws of the current EU waste management model by analysing the economic model of extended producer responsibility and collective waste management systems and to create a model for measuring the transaction costs borne by waste recovery organizations. The model was approbated by analysing the Bulgarian collective waste management systems that have been complying with the EU legislation for the last 10 years. The analysis focuses on waste oils becau...

  14. SOR/93-163 AECB Cost Recovery Fees Regulations, 1993

    International Nuclear Information System (INIS)

    1993-01-01

    The Atomic Energy Control Board (Cost Recovery Fees Regulations 1990 and subsequent amendments have been revoked and replaced by those new Regulations of 30 march 1993 which entered into force on 1 April 1993. The regulations were first made in 1990 in order to carry out the Government's policy of introducing the principle of ''user pay'' for the cost incurred by the AECB in its regulatory activities. The objective of the policy was to shift the cost of Government regulatory efforts for the taxpayer at large to those who most benefited from or whose activities were the reason for such effort. This new version of the Regulations reflects licensees' comments, e.g. extension of the period for review of proposed fees, and sets out increases in the fees. (NEA)

  15. Controlling Healthcare Costs: Just Cost Effectiveness or "Just" Cost Effectiveness?

    Science.gov (United States)

    Fleck, Leonard M

    2018-04-01

    Meeting healthcare needs is a matter of social justice. Healthcare needs are virtually limitless; however, resources, such as money, for meeting those needs, are limited. How then should we (just and caring citizens and policymakers in such a society) decide which needs must be met as a matter of justice with those limited resources? One reasonable response would be that we should use cost effectiveness as our primary criterion for making those choices. This article argues instead that cost-effectiveness considerations must be constrained by considerations of healthcare justice. The goal of this article will be to provide a preliminary account of how we might distinguish just from unjust or insufficiently just applications of cost-effectiveness analysis to some healthcare rationing problems; specifically, problems related to extraordinarily expensive targeted cancer therapies. Unconstrained compassionate appeals for resources for the medically least well-off cancer patients will be neither just nor cost effective.

  16. 40 CFR 35.928-4 - Moratorium on industrial cost recovery payments.

    Science.gov (United States)

    2010-07-01

    ... industrial users defined in paragraphs (a) and (b) of the definition in § 35.905 pay industrial cost recovery... industrial cost recovery charges incurred for accounting periods or portions of periods ending before January... defined in paragraphs (a) and (b) of the definition in § 35.905 to pay industrial cost recovery payments...

  17. A conceptional design, cost and sensitivity analysis on adsorption process for uranium recovery from seawater

    International Nuclear Information System (INIS)

    Ogata, Noboru

    1986-01-01

    The system model for a conceptional design and cost estimation was studied on a multi-layered fluidizing bed with a pump which used hydrous titanium oxide (HTO) and amidoxime resin (AOR) as adsorbents. The cost effect of some parameters, namely characteristics of adsorbent, operating conditions, price of materials and some others, were estimated, and finally there was shown a direction of improvement and a possibility of cost reduction. The conceptional design and operating condition were obtained from the balance point on expansion ratio, recovery and characteristics of adsorbent. A suitable plan was obtained from the minimum cost condition in some level of the expansion ratio and some parameters. HTO was heavy in density and cheap in price. The main results of the study indicated that the thickness of the bed was 1 m, the linear velocity of seawater was 52 m/hr, the number of bed layers was 4, the construction cost of a 100 t/y plant was 10 billion yen, and the uranium cost was 160 $/1b. AOR had a large adsorption capacity. As the main results, the thickness of bed was 0.08 m, the linear velosity of seawater was 11.6 m, the number of the bed layers was 27, the construction cost of a 100 t/y plant was 15 billion yen, and the uranium cost was 280 $/1b. The size of the 100 t/y plant was about 800 m length x 80 m depth x 30 m height at 80 % of recovery. An increase of adsorption capacity in HTO, and an increase of density and particle size in AOR had the greatest merit for cost reduction. Other effective parameters were the adsorption velocity, the recovery, temperature, the price of adsorbent, the manufacturing cost of instrument, and the rate of interest. The cost of uranium by this process had a possibility of cost reduction to 67 $/1b at HTO and 79 $/1b at AOR. (author)

  18. Indirect effects of recovery strategies

    DEFF Research Database (Denmark)

    Andersen, Ken Haste; Rice, Jake

    -based models of fish communities indicate that theserelationships have lawful dynamics that continue to be expressed, even when individualspecies become rarer - as predators or as prey. An ecosystem based management recoverystrategies of a given species or group of species should therefore not be seen...... in isolation,but the expected consequences for the rest of the ecosystem must be analyzed. We use ageneral size- and trait-based model to calculate the ecosystem effects of fishing andrecovery. We present a general analysis of a recovery strategies targeting either large fishes(consumer fishery), small fishes...

  19. The effect of pre-existing health conditions on the cost of recovery from road traffic injury: insights from data linkage of medicare and compensable injury claims in Victoria, Australia.

    Science.gov (United States)

    Hassani-Mahmooei, Behrooz; Berecki-Gisolf, Janneke; Hahn, Youjin; McClure, Roderick J

    2016-04-29

    Comorbidity is known to affect length of hospital stay and mortality after trauma but less is known about its impact on recovery beyond the immediate post-accident care period. The aim of this study was to investigate the role of pre-existing health conditions in the cost of recovery from road traffic injury using health service use records for 1 year before and after the injury. Individuals who claimed Transport Accident Commission (TAC) compensation for a non-catastrophic injury that occurred between 2010 and 2012 in Victoria, Australia and who provided consent for Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) linkage were included (n = 738) in the analysis. PBS and MBS records dating from 12 months prior to injury were provided by the Department of Human Services (Canberra, Australia). Pre-injury use of health service items and pharmaceuticals were considered to indicate pre-existing health condition. Bayesian Model Averaging techniques were used to identify the items that were most strongly correlated with recovery cost. Multivariate regression models were used to determine the impact of these items on the cost of injury recovery in terms of compensated ambulance, hospital, medical, and overall claim cost. Out of the 738 study participants, 688 used at least one medical item (total of 15,625 items) and 427 used at least one pharmaceutical item (total of 9846). The total health service cost of recovery was $10,115,714. The results show that while pre-existing conditions did not have any significant impact on the total cost of recovery, categorical costs were affected: e.g. on average, for every anaesthetic in the year before the accident, hospital cost of recovery increased by 24 % [95 % CI: 13, 36 %] and for each pathological test related to established diabetes, hospital cost increased by $10,407 [5466.78, 15346.28]. For medical costs, each anaesthetic led to $258 higher cost [174.16, 341.16] and every prescription of drugs

  20. Development of a Field Demonstration for Cost-Effective Low-Grade Heat Recovery and Use Technology Designed to Improve Efficiency and Reduce Water Usage Rates for a Coal-Fired Power Plant

    Energy Technology Data Exchange (ETDEWEB)

    Noble, Russell [Southern Company Services, Incorporated, Birmingham, AL (United States); Dombrowski, K. [AECOM Technical Services, Austin, TX (United States); Bernau, M. [AECOM Technical Services, Austin, TX (United States); Morett, D. [AECOM Technical Services, Austin, TX (United States); Maxson, A. [EPRI, Palo Alto, CA (United States); Hume, S. [EPRI, Palo Alto, CA (United States)

    2016-06-30

    Coal-based power generation systems provide reliable, low-cost power to the domestic energy sector. These systems consume large amounts of fuel and water to produce electricity and are the target of pending regulations that may require reductions in water use and improvements in thermal efficiency. While efficiency of coal-based generation has improved over time, coal power plants often do not utilize the low-grade heat contained in the flue gas and require large volumes of water for the steam cycle make-up, environmental controls, and for process cooling and heating. Low-grade heat recovery is particularly challenging for coal-fired applications, due in large part to the condensation of acid as the flue gas cools and the resulting potential corrosion of the heat recovery materials. Such systems have also not been of significant interest as recent investments on coal power plants have primarily been for environmental controls due to more stringent regulations. Also, in many regions, fuel cost is still a pass-through to the consumer, reducing the motivation for efficiency improvements. Therefore, a commercial system combining low-grade heat-recovery technologies and associated end uses to cost effectively improve efficiency and/or reduce water consumption has not yet been widely applied. However, pressures from potential new regulations and from water shortages may drive new interest, particularly in the U.S. In an effort to address this issue, the U.S. Department of Energy (DOE) has sought to identify and promote technologies to achieve this goal.

  1. 26 CFR 1.43-4 - Qualified enhanced oil recovery costs.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true Qualified enhanced oil recovery costs. 1.43-4... TAXES Credits Against Tax § 1.43-4 Qualified enhanced oil recovery costs. (a) Qualifying costs—(1) In... “qualified enhanced oil recovery costs” if the amounts are paid or incurred with respect to an asset which is...

  2. Cost analysis, cost recovery, marketing and fee-based services a guide for the health sciences librarian

    CERN Document Server

    Wood, M Sandra

    2013-01-01

    This outstanding volume won the 1986 Ida and George Eliot Prize--awarded by the Medical Library Association for the work judged most effective in furthering medical librarianship. Library professionals review the controversy behind fee-for-service programs and provide a rationale for incorporating them into contemporary library philosophies of service. Some fee-based services are necessary for survival in a society that treats information as a marketable commodity; this comprehensive book gives practical advice on cost analysis, cost recovery and marketing of reference services, and presents i

  3. The economics of recovery after pancreatic surgery: detailed cost minimization analysis of an enhanced recovery program.

    Science.gov (United States)

    Kagedan, Daniel J; Devitt, Katharine S; Tremblay St-Germain, Amélie; Ramjaun, Aliya; Cleary, Sean P; Wei, Alice C

    2017-11-01

    Clinical pathways (CPW) are considered safe and effective at decreasing postoperative length of stay (LoS), but the effect on economic costs is uncertain. This study sought to elucidate the effect of a CPW on direct hospitalization costs for patients undergoing pancreaticoduodenectomy (PD). A CPW for PD patients at a single Canadian institution was implemented. Outcomes included LoS, 30-day readmissions, and direct costs of hospital care. A retrospective cost minimization analysis compared patients undergoing PD prior to and following CPW implementation, using a bootstrapped t test and deviation-based cost modeling. 121 patients undergoing PD after CPW implementation were compared to 74 controls. Index LoS was decreased following CPW implementation (9 vs. 11 days, p = 0.005), as was total LoS (10 vs. 11 days, p = 0.003). The mean total cost of postoperative hospitalization per patient decreased in the CPW group ($15,678.45 CAD vs. $25,732.85 CAD, p = 0.024), as was the mean 30-day cost including readmissions ($16,627.15 CAD vs. $29,872.72 CAD, p = 0.016). Areas of significant cost savings included laboratory tests and imaging investigations. CPWs may generate cost savings by reducing unnecessary investigations, and improve quality of care through process standardization and decreasing practice variation. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  4. Functional Strength Training and Movement Performance Therapy for Upper Limb Recovery Early Poststroke—Efficacy, Neural Correlates, Predictive Markers, and Cost-Effectiveness: FAST-INdiCATE Trial

    Directory of Open Access Journals (Sweden)

    Susan M. Hunter

    2018-01-01

    + CPT, which did not differ statistically (p = 0.298. Correlations between ARAT change scores and baseline neural values were between 0.199, p = 0.320 for MPT + CPT RMT (n = 27 and −0.147, p = 0.385 for asymmetry of corticospinal tracts FA (n = 37. Interaction effects between neural values and ARAT change between baseline and outcome were not statistically significant.ConclusionsThere was no significant difference in upper limb improvement between FST and MPT. Baseline neural measures did not correlate with upper limb recovery or predict therapy response.Trial registrationCurrent Controlled Trials: ISRCT 19090862, http://www.controlled-trials.com

  5. A Stochastic Market Design With Revenue Adequacy and Cost Recovery by Scenario: Benefits and Costs

    DEFF Research Database (Denmark)

    Kazempour, Jalal; Pinson, Pierre; Hobbs, Benjamin F.

    2018-01-01

    Two desirable properties of electricity market mechanisms include: i) revenue adequacy for the market, and ii) cost recovery for all generators. Previously proposed stochastic market-clearing mechanisms satisfy both properties in expectation only, or satisfy one property by scenario and another...... scheme that ensures both properties by scenario. However, this approach is cost-inefficient in general and may sacrifice other desirable market attributes. Undesirable consequences include: one group of participants will have to pay more to ensure that all other participants have their costs covered......, and thus their prices will not be equilibrium supporting; and day-ahead and real-time prices are not arbitraged in expectation, although this can be fixed by allowing virtual bidders to arbitrage but at the potential cost of increased market inefficiency. Considering these pros and cons, we propose our...

  6. 40 CFR 35.928-3 - Implementation of the industrial cost recovery system.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Implementation of the industrial cost...-Clean Water Act § 35.928-3 Implementation of the industrial cost recovery system. (a) When a grantee's industrial cost recovery system is approved, implementation of the approved system shall become a condition...

  7. Cost benefit analysis cost effectiveness analysis

    International Nuclear Information System (INIS)

    Lombard, J.

    1986-09-01

    The comparison of various protection options in order to determine which is the best compromise between cost of protection and residual risk is the purpose of the ALARA procedure. The use of decision-aiding techniques is valuable as an aid to selection procedures. The purpose of this study is to introduce two rather simple and well known decision aiding techniques: the cost-effectiveness analysis and the cost-benefit analysis. These two techniques are relevant for the great part of ALARA decisions which need the use of a quantitative technique. The study is based on an hypothetical case of 10 protection options. Four methods are applied to the data

  8. Cost-Benefit Analysis of the Implementation of an Enhanced Recovery Program in Liver Surgery.

    Science.gov (United States)

    Joliat, Gaëtan-Romain; Labgaa, Ismaïl; Hübner, Martin; Blanc, Catherine; Griesser, Anne-Claude; Schäfer, Markus; Demartines, Nicolas

    2016-10-01

    Enhanced recovery after surgery (ERAS) programs have been shown to ease the postoperative recovery and improve clinical outcomes for various surgery types. ERAS cost-effectiveness was demonstrated for colorectal surgery but not for liver surgery. The present study aim was to analyze the implementation costs and benefits of a specific ERAS program in liver surgery. A dedicated ERAS protocol for liver surgery was implemented in our department in July 2013. The subsequent year all consecutive patients undergoing liver surgery were treated according to this protocol (ERAS group). They were compared in terms of real in-hospital costs with a patient series before ERAS implementation (pre-ERAS group). Mean costs per patient were compared with a bootstrap T test. A cost-minimization analysis was performed. Seventy-four ERAS patients were compared with 100 pre-ERAS patients. There were no significant pre- and intraoperative differences between the two groups, except for the laparoscopy number (n = 18 ERAS, n = 9 pre-ERAS, p = 0.010). Overall postoperative complications were observed in 36 (49 %) and 64 patients (64 %) in the ERAS and pre-ERAS groups, respectively (p = 0.046). The median length of stay was significantly shorter for the ERAS group (8 vs. 10 days, p = 0.006). The total mean costs per patient were €38,726 and €42,356 for ERAS and pre-ERAS (p = 0.467). The cost-minimization analysis showed a total mean cost reduction of €3080 per patient after ERAS implementation. ERAS implementation for liver surgery induced a non-significant decrease in cost compared to standard care. Significant decreased complication rate and hospital stay were observed in the ERAS group.

  9. Cost analysis and ecological benefits of environmental recovery methodologies in bauxite mining

    OpenAIRE

    Guimarães,João Carlos Costa; Barros,Dalmo Arantes de; Pereira,José Aldo Alves; Silva,Rossi Allan; Oliveira,Antonio Donizette de; Borges,Luís Antônio Coimbra

    2013-01-01

    This work analyzed and compared three methods of environmental recovery in bauxite mining commonly used in Poços de Caldas Plateau, MG, by means of recovery costs and ecological benefits. Earnings and costs data of environmental recovery activities were obtained for the areas that belonged to the Companhia Geral de Minas – CGM, on properties sited in the city of Poços de Caldas, MG. The amount of costs of these activities was used to compare the recovery methods by updating them monetarily to...

  10. 75 FR 49508 - Recovery Policy, RP9525.7, Labor Costs-Emergency Work

    Science.gov (United States)

    2010-08-13

    ...] Recovery Policy, RP9525.7, Labor Costs--Emergency Work AGENCY: Federal Emergency Management Agency, DHS... (FEMA) is accepting comments on RP9525.7, Labor Costs--Emergency Work. This is an existing policy that is scheduled for review to ensure that Recovery Directorate policies are up to date, incorporate...

  11. Chloride metallurgy for uranium recovery: concept and costs

    International Nuclear Information System (INIS)

    Campbell, M.C.; Ritcey, G.M.; Joe, E.G.

    1982-01-01

    Uranium, thorium and radium are all effectively solubilized in chloride media. This provides a means to separate and isolate these species for ultimate sale or disposal. The laboratory work on the applications of hydrochloric acid leaching, chlorine assisted leaching and high temperature chlorination is reviewed. An indication of costs and benefits is provided to enable the evaluation of this technology as an option for reducing the environmental impact of tailings

  12. Can treatment and disposal costs be reduced through metal recovery?

    Science.gov (United States)

    Smith, Kathleen S.; Figueroa, Linda; Plumlee, Geoffrey S.

    2015-01-01

    This paper describes a framework to conduct a “metal-recovery feasibility assessment” for mining influenced water (MIW) and associated treatment sludge. There are multiple considerations in such a determination, including the geologic/geochemical feasibility, market feasibility, technical feasibility, economic feasibility, and administrative feasibility. Each of these considerations needs to be evaluated to determine the practicality of metal recovery from a particular MIW.

  13. 76 FR 54223 - Notice of Proposed Administrative Cost Recovery Settlement Pursuant to the Comprehensive...

    Science.gov (United States)

    2011-08-31

    ... Costs Incurred at Marine Corps Logistics Base Barstow, CA AGENCY: Department of the Navy, DoD. ACTION... of response costs incurred by the DON at the Site. The proposed Administrative Settlement resolves... DEPARTMENT OF DEFENSE Department of the Navy Notice of Proposed Administrative Cost Recovery...

  14. A novel bio-electrochemical system with sand/activated carbon separator, Al anode and bio-anode integrated micro-electrolysis/electro-flocculation cost effectively treated high load wastewater with energy recovery.

    Science.gov (United States)

    Gao, Changfei; Liu, Lifen; Yang, Fenglin

    2018-02-01

    A novel bio-electrochemical system (BES) was developed by integrating micro-electrolysis/electro-flocculation from attaching a sacrificing Al anode to the bio-anode, it effectively treated high load wastewater with energy recovery (maximum power density of 365.1 mW/m 3 and a maximum cell voltage of 0.97 V), and achieving high removals of COD (>99.4%), NH 4 + -N (>98.7%) and TP (>98.6%). The anode chamber contains microbes, activated carbon (AC)/graphite granules and Al anode. It was separated from the cathode chamber containing bifunctional catalytic and filtration membrane cathode (loaded with Fe/Mn/C/F/O catalyst) by a multi-medium chamber (MMC) filled with manganese sand and activated carbon granules, which replaced expensive PEM and reduced cost. An air contact oxidation bed for aeration was still adopted before liquid entering the cathode chamber. micro-electrolysis/electro-flocculation helps in achieving high removal efficiencies and contributes to membrane fouling migration. The increase of activated carbon in the separator MMC increased power generation and reduced system electric resistance. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Selection and application of effective LNAPL recovery techniques

    International Nuclear Information System (INIS)

    Fulton, D.E.

    1996-01-01

    The accumulation of light non-aqueous phase liquids (LNAPL) such as gasoline, diesel, fuel oil and lubricating oil resulting from historical or catastrophic releases, is present at numerous industrial and hazardous waste sites. Initiating LNAPL removal is the first step in remediating impacted groundwater with the LNAPL recovery process having a profound effect on the ability to cost effectively achieve site closure. In many cases, LNAPL recovery precedes full-scale groundwater design activities or even final site characterization due to regulatory compliance issues. Therefore, the timely and effective implementation of a LNAPL recovery system can result in reduced project costs by mitigating further plume migration, achieving maximum volume of recoverable hydrocarbons, eliminating the source area associated with dissolved phase contamination, and allowing comprehensive groundwater remediation to be employed sooner. Effective LNAPL recovery systems begin with evaluating a number of site-specific parameters to quantify the physical characteristics of the type of LNAPL to be recovered, the hydrogeological environment, LNAPL, plume geometry, and the specified client or regulatory cleanup goals. These parameters are discussed along with their significance in developing a conceptual understanding of the site

  16. Effect of hydrotherapy on recovery from fatigue.

    Science.gov (United States)

    Vaile, J; Halson, S; Gill, N; Dawson, B

    2008-07-01

    The present study investigated the effects of three hydrotherapy interventions on next day performance recovery following strenuous training. Twelve cyclists completed four experimental trials differing only in 14-min recovery intervention: cold water immersion (CWI), hot water immersion (HWI), contrast water therapy (CWT), or passive recovery (PAS). Each trial comprised five consecutive exercise days of 105-min duration, including 66 maximal effort sprints. Additionally, subjects performed a total of 9-min sustained effort (time trial - TT). After completing each exercise session, athletes performed one of four recovery interventions (randomly assigned to each trial). Performance (average power), core temperature, heart rate (HR), and rating of perceived exertion (RPE) were recorded throughout each session. Sprint (0.1 - 2.2 %) and TT (0.0 - 1.7 %) performance were enhanced across the five-day trial following CWI and CWT, when compared to HWI and PAS. Additionally, differences in rectal temperature were observed between interventions immediately and 15-min post-recovery; however, no significant differences were observed in HR or RPE regardless of day of trial/intervention. Overall, CWI and CWT appear to improve recovery from high-intensity cycling when compared to HWI and PAS, with athletes better able to maintain performance across a five-day period.

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

    OpenAIRE

    Alam, Khurshid; Ahmed, Shakil

    2010-01-01

    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. Give...

  18. Costs, CO{sub 2}- and primary energy balances of forest-fuel recovery systems at different forest productivity

    Energy Technology Data Exchange (ETDEWEB)

    Eriksson, Lisa; Gustavsson, Leif [Ecotechnology, Department of Engineering and Sustainable Development, Mid Sweden University, SE-831 25 Oestersund (Sweden)

    2010-05-15

    Here we examine the cost, primary energy use, and net carbon emissions associated with removal and use of forest residues for energy, considering different recovery systems, terrain, forwarding distance and forest productivity. We show the potential recovery of forest fuel for Sweden, its costs and net carbon emissions from primary energy use and avoided fossil carbon emissions. The potential annual net recovery of forest fuel is about 66 TWh, which would cost one billion EUR{sub 2005} to recover and would reduce fossil emissions by 6.9 Mt carbon if coal were replaced. Of the forest fuel, 56% is situated in normal terrain with productivity of >30 t dry-matter ha{sup -1} and of this, 65% has a forwarding distance of <400 m. In normal terrain with >30 t dry-matter ha{sup -1} the cost increase for the recovery of forest fuel, excluding stumps, is around 4-6% and 8-11% for medium and longer forwarding distances, respectively. The stump and small roundwood systems are less cost-effective at lower forest fuel intensity per area. For systems where loose material is forwarded, less dry-matter per hectare increases costs by 6-7%, while a difficult terrain increases costs by 3-4%. Still, these systems are quite cost-effective. The cost of spreading ash is around 40 EUR{sub 2005} ha{sup -1}, while primary energy use for spreading ash in areas where logging residues, stumps, and small roundwood are recovered is about 0.025% of the recovered bioenergy. (author)

  19. Effects of Microwave Radiation on Oil Recovery

    Science.gov (United States)

    Esmaeili, Abdollah

    2011-12-01

    A variety of oil recovery methods have been developed and applied to mature and depleted reservoirs in order to improve the efficiency. Microwave radiation oil recovery method is a relatively new method and has been of great interest in the recent years. Crude oil is typically co-mingled with suspended solids and water. To increase oil recovery, it is necessary to remove these components. The separation of oil from water and solids using gravitational settling methods is typically incomplete. Oil-in-water and oil-water-solid emulsions can be demulsified and separated into their individual layers by microwave radiation. The data also show that microwave separation is faster than gravity separation and can be faster than conventional heating at many conditions. After separation of emulsion into water and oil layers, water can be discharged and oil is collected. High-frequency microwave recycling process can recover oil and gases from oil shale, residual oil, drill cuttings, tar sands oil, contaminated dredge/sediments, tires and plastics with significantly greater yields and lower costs than are available utilizing existing known technologies. This process is environmentally friendly, fuel-generating recycler to reduce waste, cut emissions, and save energy. This paper presents a critical review of Microwave radiation method for oil recovery.

  20. Cost effectiveness analysis in radiopharmacy

    International Nuclear Information System (INIS)

    Carpentier, N.; Verbeke, S.; Ducloux, T.

    1999-01-01

    Objective: to evaluate the cost effectiveness of radiopharmaceuticals and their quality control. Materials and methods: this retrospective study was made in the Nuclear Medicine Department of the University Hospital of Limoges. Radiopharmaceutical costs were obtained with adding the price of the radiotracer, the materials, the equipments, the labour, the running expenses and the radioisotope. The costs of quality control were obtained with adding the price of labour, materials, equipments, running expenses and the cost of the quality control of 99m Tc eluate. Results: during 1998, 2106 radiopharmaceuticals were prepared in the Nuclear Medicine Department. The mean cost effectiveness of radiopharmaceutical was 1430 francs (846 to 4260). The mean cost effectiveness of quality control was 163 francs (84 to 343). The rise of the radiopharmaceutical cost induced by quality control was 11%. Conclusion: the technical methodology of quality control must be mastered to optimize the cost of this operation. (author)

  1. Is high recovery more effective than expected recovery in addressing service failure? - a moral judgment perspective

    OpenAIRE

    Chen, Tong; Ma, Ke; Bian, Xuemei; Zheng, Chundong; Devlin, James

    2018-01-01

    In the context of two distinctive consumer categories and two different product settings, this research examines the effects of recovery on recovery performance as a function of consumer moral judgment of service failure. The findings of two studies reveal that consumers' response to recovery anchors on the magnitude of recovery but these responses are adjusted according to consumers' moral judgment of service failure. Specifically, consumers react more positively toward expected recovery tha...

  2. Energy Recovery Hydropower: Prospects for Off-Setting Electricity Costs for Agricultural, Municipal, and Industrial Water Providers and Users; July 2017 - September 2017

    Energy Technology Data Exchange (ETDEWEB)

    Levine, Aaron L. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Curtis, Taylor L. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Johnson, Kurt [Telluride Energy; Telluride, CO (United States)

    2018-01-11

    Energy recovery hydropower is one of the most cost-effective types of new hydropower development because it is constructed utilizing existing infrastructure, and it is typically able to complete Federal Energy Regulatory Commission (FERC) review in 60 days. Recent changes in federal and state policy have supported energy recovery hydropower. In addition, some states have developed programs and policies to support energy recovery hydropower, including resource assessments, regulatory streamlining initiatives, and grant and loan programs to reduce project development costs. This report examines current federal and state policy drivers for energy recovery hydropower, reviews market trends, and looks ahead at future federal resource assessments and hydropower reform legislation.

  3. Incentive pricing and cost recovery at the basin scale.

    Science.gov (United States)

    Ward, Frank A; Pulido-Velazquez, Manuel

    2009-01-01

    Incentive pricing programs have potential to promote economically efficient water use patterns and provide a revenue source to compensate for environmental damages. However, incentive pricing may impose disproportionate costs and aggravate poverty where high prices are levied for basic human needs. This paper presents an analysis of a two-tiered water pricing system that sets a low price for subsistence needs, while charging a price equal to marginal cost, including environmental cost, for discretionary uses. This pricing arrangement can promote efficient and sustainable water use patterns, goals set by the European Water Framework Directive, while meeting subsistence needs of poor households. Using data from the Rio Grande Basin of North America, a dynamic nonlinear program, maximizes the basin's total net economic and environmental benefits subject to several hydrological and institutional constraints. Supply costs, environmental costs, and resource costs are integrated in a model of a river basin's hydrology, economics, and institutions. Three programs are compared: (1) Law of the River, in which water allocations and prices are determined by rules governing water transfers; (2) marginal cost pricing, in which households pay the full marginal cost of supplying treated water; (3) two-tiered pricing, in which households' subsistence water needs are priced cheaply, while discretionary uses are priced at efficient levels. Compared to the Law of the River and marginal cost pricing, two-tiered pricing performs well for efficiency and adequately for sustainability and equity. Findings provide a general framework for formulating water pricing programs that promote economically and environmentally efficient water use programs while also addressing other policy goals.

  4. Marginal pricing of transmission services: An analysis of cost recovery

    International Nuclear Information System (INIS)

    Perez-Arriaga, I.J.; Rubio, F.J.; Puerta, J.F.; Arceluz, J.; Marin, J.

    1995-01-01

    This paper presents an in-depth analysis of network revenues computed with marginal pricing, and in particular it investigates the reasons why marginal prices fail to recover the total incurred network costs in actual power systems. The basic theoretical results are presented and the major causes of the mismatch between network costs and marginal revenues are identified and illustrated with numerical examples, some tutorial and others of realistic size. The regulatory implications of marginal network pricing in the context of competitive electricity markets are analyzed, and suggestions are provided for the meaningful allocation of the costs of the network among its users

  5. Marginal pricing of transmission services: An analysis of cost recovery

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Arriaga, I.J.; Rubio, F.J. [Univ. Pontificia Comillas, Madrid (Spain); Puerta, J.F.; Arceluz, J.; Marin, J. [IBERDROLA, Bilbao (Spain). Unidad de Planificacion Estrategica

    1995-02-01

    This paper presents an in-depth analysis of network revenues computed with marginal pricing, and in particular it investigates the reasons why marginal prices fail to recover the total incurred network costs in actual power systems. The basic theoretical results are presented and the major causes of the mismatch between network costs and marginal revenues are identified and illustrated with numerical examples, some tutorial and others of realistic size. The regulatory implications of marginal network pricing in the context of competitive electricity markets are analyzed, and suggestions are provided for the meaningful allocation of the costs of the network among its users.

  6. Marginal pricing of transmission services. An analysis of cost recovery

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Arriaga, I.J.., Rubio, F.J. [Instituto de Investigacion Technologica, Universidad Pontificia Comillas, Madrid (Spain); Puerta, J.F.; Arceluz, J.; Marin, J. [Unidad de Planificacion Estrategica, Iberdrola, Madrid (Spain)

    1996-12-31

    The authors present an in-depth analysis of network revenues that are computed with marginal pricing, and investigate the reasons why marginal prices in actual power systems fail to recover total incurred network costs. The major causes of the failure are identified and illustrated with numerical examples. The paper analyzes the regulatory implications of marginal network pricing in the context of competitive electricity markets and provides suggestions for the meaningful allocation of network costs among users. 5 figs., 9 tabs., 8 refs.

  7. Marginal pricing of transmission services. An analysis of cost recovery

    International Nuclear Information System (INIS)

    Perez-Arriaga, I.J.., Rubio, F.J.; Puerta, J.F.; Arceluz, J.; Marin, J.

    1996-01-01

    The authors present an in-depth analysis of network revenues that are computed with marginal pricing, and investigate the reasons why marginal prices in actual power systems fail to recover total incurred network costs. The major causes of the failure are identified and illustrated with numerical examples. The paper analyzes the regulatory implications of marginal network pricing in the context of competitive electricity markets and provides suggestions for the meaningful allocation of network costs among users. 5 figs., 9 tabs., 8 refs

  8. 43 CFR 426.23 - Recovery of operation and maintenance (O&M) costs.

    Science.gov (United States)

    2010-10-01

    ... operation and maintenance (O&M) costs. (a) General. All new, amended, and renewed contracts shall provide... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Recovery of operation and maintenance (O&M) costs. 426.23 Section 426.23 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF...

  9. 15 CFR 904.507 - Recovery of certain storage costs.

    Science.gov (United States)

    2010-01-01

    ... fee for expenses to the United States connected with the transfer, board, handling or storage of such... States connected with the storage, care and maintenance of such property. Within a reasonable time after... the bill objects to the reasonableness of the costs assessed he or she may, within 30 days of receipt...

  10. Reducing Building HVAC Costs with Site-Recovery Energy

    Science.gov (United States)

    Pargeter, Stephen J.

    2012-01-01

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

  11. Cost recovery of congested infrastructure under market power

    NARCIS (Netherlands)

    Verhoef, Erik T.

    2017-01-01

    The Mohring–Harwitz (1962) theorem states that the degree of self-financing of congested infrastructure is equal to the elasticity of the capacity cost function in the optimum, so that under neutral scale economies exact self-financing applies. The theorem breaks down when the infrastructure is used

  12. Resource-recovery facilities: Production and cost functions, and debt-financing issues

    International Nuclear Information System (INIS)

    Simonsen, W.S.

    1991-01-01

    Some of the fiscal questions relating to resource-recovery, or trash-burning, facilities are addressed. Production and cost functions for resource-recovery facilities are estimated using regression analysis. Whether or not there are returns to scale are addressed using the production and cost-function framework. Production functions are also estimated using data envelopment analysis (DEA), and results are compared to the regression results. DEA is a linear-program-based technique that can provide information about the production process. The data used to estimate the production and cost functions were collected from the Resource Recovery Yearbook. Once the decision is made to construct a resource-recovery facility, it needs to be financed. The high cost of these facilities usually prohibits financing construction out of regular operating revenues. Therefore, the issues a government faces when debt is used to finance a resource-recovery facility are analyzed. The most important public policy finding is that increasing economies of scale do not seem to be present for resource-recovery facilities

  13. Waste Processing Cost Recovery at Los Alamos National Laboratory-Analysis and Recommendations

    International Nuclear Information System (INIS)

    Booth, St. R.

    2009-01-01

    Los Alamos National Laboratory is implementing full cost recovery for waste processing in fiscal year 2009 (FY2009), after a transition year in FY2008. Waste processing cost recovery has been implemented in various forms across the nuclear weapons complex and in corporate America. The fundamental reasoning of sending accurate price signals to waste generators is economically sound, and leads to waste minimization and reduced waste expense over time. However, Los Alamos faces significant implementation challenges because of its status as a government-owned, contractor-operated national scientific institution with a diverse suite of experimental and environmental cleanup activities, and the fact that this represents a fundamental change in how waste processing is viewed by the institution. This paper describes the issues involved during the transition to cost recovery and the ultimate selection of the business model. Of the six alternative cost recovery models evaluated, the business model chosen to be implemented in FY2009 is Recharge Plus Generators Pay Distributed Direct. Under this model, all generators who produce waste must pay a distributed direct share associated with their specific waste type to use a waste processing capability. This cost share is calculated using the distributed direct method on the fixed cost only, i.e., the fixed cost share is based on each program's forecast proportion of the total Los Alamos volume forecast of each waste type. (Fixed activities are those required to establish the waste processing capability, i.e., to make the process ready, permitted, certified, and prepared to handle the first unit of waste. Therefore, the fixed cost ends at the point just before waste begins to be processed. The activities to actually process the waste are considered variable.) The volume of waste actually sent for processing is charged a unit cost based solely on the variable cost of disposing of that waste. The total cost recovered each year is the

  14. 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

  15. Energy and cost savings potential of oscillating heat pipes for waste heat recovery ventilation

    Directory of Open Access Journals (Sweden)

    Govinda Mahajan

    2017-11-01

    Full Text Available The feasibility of using finned oscillating heat pipes (OHPs for heat exchange between counter-flowing air streams in HVAC air systems (i.e., outdoor and exhaust air flows, along with the associated cost savings in typical North American climates, is investigated. For a prescribed temperature difference and volumetric flow rate of air, rudimentary design parameters for a viable OHP Heat Recovery Ventilator (OHP-HRV were determined using the ε-NTU (effectiveness-Number of Transfer Unit method. The two-phase heat transfer within the OHP-HRV is modeled via effective evaporation/condensation heat transfer coefficients, while the latent heat transfer required to initiate OHP operation via boiling and evaporation is also considered. Results suggest that an OHP-HRV can possess a reasonable pressure drop (5 kW. The proposed OHP-HRV can possess an effectiveness near 0.5 and can pre-cool/heat HVAC air by >5°C. Potential energy and cost savings associated with using an OHP-HRV were estimated for commercial building envelopes in various regions of the United States. It is found that the proposed OHP-HRV can save more than $2500 annually in cities that have continental climatic conditions, such as Chicago and Denver, and for the selected locations the average yearly cost savings per building is found to be on-the-order of $700. Overall, the OHP-HRV shows potential in effectively reducing energy consumption and the operational cost of air handling units in buildings.

  16. Recovery Act: Low Cost Integrated Substrate for OLED Lighting Development

    Energy Technology Data Exchange (ETDEWEB)

    Benton, Scott [PPG Industries, Inc., Pittsburgh, PA (United States); Bhandari, Abhinav [PPG Industries, Inc., Pittsburgh, PA (United States)

    2012-12-26

    PPG pursued the development of an integrated substrate, including the anode, external, and internal extraction layers. The objective of PPG's program was to achieve cost reductions by displacing the existing expensive borosilicate or double-side polished float glass substrates and developing alternative electrodes and scalable light extraction layer technologies through focused and short-term applied research. One of the key highlights of the project was proving the feasibility of using PPG's high transmission Solarphire® float glass as a substrate to consistently achieve organic lightemitting diode (OLED) devices with good performance and high yields. Under this program, four low-cost alternatives to the Indium Tin Oxide (ITO) anode were investigated using pilot-scale magnetron sputtered vacuum deposition (MSVD) and chemical vapor deposition (CVD) technologies. The anodes were evaluated by fabricating small and large phosphorescent organic lightemitting diode (PHOLED) devices at Universal Display Corporation (UDC). The device performance and life-times comparable to commercially available ITO anodes were demonstrated. A cost-benefit analysis was performed to down-select two anodes for further low-cost process development. Additionally, PPG developed and evaluated a number of scalable and compatible internal and external extraction layer concepts such as scattering layers on the outside of the glass substrate or between the transparent anode and the glass interface. In one external extraction layer (EEL) approach, sol-gel sprayed pyrolytic coatings were deposited using lab scale equipment by hand or automated spraying of sol-gel solutions on hot glass, followed by optimizing of scattering with minimal absorption. In another EEL approach, PPG tested large-area glass texturing by scratching a glass surface with an abrasive roller and acid etching. Efficacy enhancements of 1.27x were demonstrated using white PHOLED devices for 2.0mm substrates which are

  17. [Cost recovery for the treatment of retinal and vitreal diseases by pars plana vitrectomy under the German DRG system].

    Science.gov (United States)

    Framme, C; Franz, D; Mrosek, S; Helbig, H

    2007-10-01

    environment is not covered for complex procedures requiring more cost-effective material and personnel time. To consider an adequate cost recovery for these procedures a DRG split for both DRGs (C03Z and C17Z) in basic ppVs and complex ppVs is required. We recommend this proposal for the InEK.

  18. 75 FR 55678 - Minerals Management: Adjustment of Cost Recovery Fees

    Science.gov (United States)

    2010-09-14

    ... location. DATES: This final rule is effective October 1, 2010. FOR FURTHER INFORMATION CONTACT: Steve... economy, a sector of the economy, productivity, competition, jobs, the environment, public health or...

  19. Costs and cost-effectiveness of periviable care.

    Science.gov (United States)

    Caughey, Aaron B; Burchfield, David J

    2014-02-01

    With increasing concerns regarding rapidly expanding healthcare costs, cost-effectiveness analysis allows assessment of whether marginal gains from new technology are worth the increased costs. Particular methodologic issues related to cost and cost-effectiveness analysis in the area of neonatal and periviable care include how costs are estimated, such as the use of charges and whether long-term costs are included; the challenges of measuring utilities; and whether to use a maternal, neonatal, or dual perspective in such analyses. A number of studies over the past three decades have examined the costs and the cost-effectiveness of neonatal and periviable care. Broadly, while neonatal care is costly, it is also cost effective as it produces both life-years and quality-adjusted life-years (QALYs). However, as the gestational age of the neonate decreases, the costs increase and the cost-effectiveness threshold is harder to achieve. In the periviable range of gestational age (22-24 weeks of gestation), whether the care is cost effective is questionable and is dependent on the perspective. Understanding the methodology and salient issues of cost-effectiveness analysis is critical for researchers, editors, and clinicians to accurately interpret results of the growing body of cost-effectiveness studies related to the care of periviable pregnancies and neonates. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. 77 FR 4997 - Proposed Information Collection; Comment Request; Alaska Individual Fishing Quota Cost Recovery...

    Science.gov (United States)

    2012-02-01

    ... Jessup, Departmental Paperwork Clearance Officer, Department of Commerce, Room 6616, 14th and... about the value of landings of IFQ species and to calculate and submit fees. The Cost Recovery Program.... Estimated Number of Respondents: 2,500. Estimated Time per Response: 2 hours to complete IFQ Permit Holder...

  1. Cost analysis and ecological benefits of environmental recovery methodologies in bauxite mining

    Directory of Open Access Journals (Sweden)

    João Carlos Costa Guimarães

    2013-03-01

    Full Text Available This work analyzed and compared three methods of environmental recovery in bauxite mining commonly used in Poços de Caldas Plateau, MG, by means of recovery costs and ecological benefits. Earnings and costs data of environmental recovery activities were obtained for the areas that belonged to the Companhia Geral de Minas – CGM, on properties sited in the city of Poços de Caldas, MG. The amount of costs of these activities was used to compare the recovery methods by updating them monetarily to a reference date, in other words, the present moment. It is concluded that the difference between the present value of costs for simple restoration and rehabilitation activities are less than 1% and that between the complete restoration and rehabilitation is about 15.12%, suggesting that the choice of the methods to be used must be based on the ecological earnings proportional to each of them. The methodology of environmental restoration of the mining areas emphasizes the ecological variables in the process of establishment of the community, to the detriment of complex ecological aspects, which show difficulties in measuring the actual moment of the development of the ecosystem considered.

  2. Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost.

    Science.gov (United States)

    Schoenbaum, Michael; Butler, Brittany; Kataoka, Sheryl; Norquist, Grayson; Springgate, Benjamin; Sullivan, Greer; Duan, Naihua; Kessler, Ronald C; Wells, Kenneth

    2009-08-01

    Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes. To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study. Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input. A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita. Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination. Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources. Full implementation would cost $1133 per capita, or more than $12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately. Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.

  3. Cost analysis of enhanced recovery after surgery in microvascular breast reconstruction.

    Science.gov (United States)

    Oh, Christine; Moriarty, James; Borah, Bijan J; Mara, Kristin C; Harmsen, William S; Saint-Cyr, Michel; Lemaine, Valerie

    2018-06-01

    Enhanced recovery after surgery (ERAS) pathways have been shown in multiple surgical specialties to decrease hospital length of stay (LOS) after surgery. ERAS in breast reconstruction has been found to decrease hospital LOS and inpatient opioid use. ERAS protocols can facilitate a patient's recovery and can potentially increase the quality of care while decreasing costs. A standardized ERAS pathway was developed through multidisciplinary collaboration. It addressed all phases of surgical care for patients undergoing free-flap breast reconstruction utilizing an abdominal donor site. In this retrospective cohort study, clinical variables associated with hospitalization costs for patients who underwent free-flap breast reconstruction with the ERAS pathway were compared with those of historical controls, termed traditional recovery after surgery (TRAS). All patients included in the study underwent surgery between September 2010 and September 2014. Predicted costs of the study groups were compared using generalized linear modeling. A total of 200 patients were analyzed: 82 in the ERAS cohort and 118 in the TRAS cohort. Clinical variables that were identified to potentially affect costs were found to have a statistically significant difference between groups and included unilateral versus bilateral procedures (p = 0.04) and the need for postoperative blood transfusion (p = 0.03). The cost regression analysis on the two cohorts was adjusted for these significant variables. Adjusted mean costs of patients with ERAS were found to be $4,576 lesser than those of the TRAS control group ($38,688 versus $43,264). Implementation of the ERAS pathway was associated with significantly decreased costs when compared to historical controls. There has been a healthcare focus toward prudent resource allocation, which dictates the need for plastic surgeons to recognize economic evaluation of clinical practice. The ERAS pathway can increase healthcare accountability by improving

  4. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial

    Directory of Open Access Journals (Sweden)

    Bergman Gert JD

    2010-09-01

    Full Text Available Abstract Background Shoulder complaints are common in primary care and have unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC by the general practitioner in the treatment of shoulder complaints. Methods This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy and were allocated at random (yes/no to manipulative therapy (manipulation and mobilization. Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Results Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%, but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (€1167 vs. €555. This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at €2876. Conclusion Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. International Standard

  5. LOWER COST METHODS FOR IMPROVED OIL RECOVERY (IOR) VIA SURFACTANT FLOODING

    Energy Technology Data Exchange (ETDEWEB)

    William A. Goddard III; Yongchun Tang; Patrick Shuler; Mario Blanco; Seung Soon Jang; Shiang-Tai Lin; Prabal Maiti; Yongfu Wu; Stefan Iglauer; Xiaohang Zhang

    2004-09-01

    This report provides a summary of the work performed in this 3-year project sponsored by DOE. The overall objective of this project is to identify new, potentially more cost-effective surfactant formulations for improved oil recovery (IOR). The general approach is to use an integrated experimental and computational chemistry effort to improve our understanding of the link between surfactant structure and performance, and from this knowledge, develop improved IOR surfactant formulations. Accomplishments for the project include: (1) completion of a literature review to assemble current and new surfactant IOR ideas, (2) Development of new atomistic-level MD (molecular dynamic) modeling methodologies to calculate IFT (interfacial tension) rigorously from first principles, (3) exploration of less computationally intensive mesoscale methods to estimate IFT, Quantitative Structure Property Relationship (QSPR), and cohesive energy density (CED) calculations, (4) experiments to screen many surfactant structures for desirable low IFT and solid adsorption behavior, and (5) further experimental characterization of the more promising new candidate formulations (based on alkyl polyglycosides (APG) and alkyl propoxy sulfate surfactants). Important findings from this project include: (1) the IFT between two pure substances may be calculated quantitatively from fundamental principles using Molecular Dynamics, the same approach can provide qualitative results for ternary systems containing a surfactant, (2) low concentrations of alkyl polyglycoside surfactants have potential for IOR (Improved Oil Recovery) applications from a technical standpoint (if formulated properly with a cosurfactant, they can create a low IFT at low concentration) and also are viable economically as they are available commercially, and (3) the alkylpropoxy sulfate surfactants have promising IFT performance also, plus these surfactants can have high optimal salinity and so may be attractive for use in higher

  6. 75 FR 33379 - Railroad Cost Recovery Procedures-Productivity Adjustment; Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2010-06-11

    ... information is contained in the Board's June 14, 2010 decision, which is available on our website at http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the office of Public... Cost Adjustment Factor AGENCY: Surface Transportation Board. [[Page 33380

  7. Can a Costly Intervention Be Cost-effective?

    Science.gov (United States)

    Foster, E. Michael; Jones, Damon

    2009-01-01

    Objectives To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. Design Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. Results Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. Conclusions Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations. PMID:17088509

  8. Cost Recovery in Urban Water Services : Select Experiences in Indian Cities

    OpenAIRE

    Gupta, Anjali Sen

    2011-01-01

    The report draws on a Water and Sanitation Program (WSP) study from 2008 which made a comparative analysis of 23 Urban Local Bodies (ULBs)-looking at seven cities in detail and another 16 based on secondary data-to understand the factors affecting cost recovery in India and provide an indication of current performance. It also draws out examples and lessons to inform reform approaches and ...

  9. Decommissioning cost recovery in the United States: lessons learned from Connecticut Yankee NPP

    International Nuclear Information System (INIS)

    Joosten, J.

    1999-01-01

    The international audience at ICONE-7 is already familiar with the roles of the owner and the NRC in ensuring the technical and safety performance goals of nuclear plant decommissioning. This paper addresses the role of the economic regulator since the pursuit of technical and safety goals must necessarily carry with them -a price tag- and owners must be concerned with the recovery of those costs. Answers to questions about how to pay and who should pay for decommissioning can very often influence nuclear power plant owner's decision-making. In the United States, most nuclear power plants are privately owned. Nevertheless, their owners are not totally free to determine the plant's economics or profitability. Instead, plant owners must sell their electricity to consumers in a regulated market wherein the price of electricity and terms of sale are controlled by the government. Under this regulatory regime, utilities are generally allowed to recover their investment costs -including decommissioning costs- provided that such costs are prudently, incurred. However, when an owner retires the plant prematurely, the prudence of his actions -up to and including the shutdown- are likely to be challenged. In 1997, for example, the owners of the Connecticut Yankee reactor faced a stiff challenge to the recovery of decommissioning costs when they shut down the plant ten years before license expiration. The Connecticut Yankee case thus provides valuable insights into the role of economic regulation on a nuclear plant's decommissioning strategy. (author)

  10. A Departmental Cost-Effectiveness Model.

    Science.gov (United States)

    Holleman, Thomas, Jr.

    In establishing a departmental cost-effectiveness model, the traditional cost-effectiveness model was discussed and equipped with a distant and deflation equation for both benefits and costs. Next, the economics of costing was examined and program costing procedures developed. Then, the model construct was described as it was structured around the…

  11. Inspections - a cost effective approach

    International Nuclear Information System (INIS)

    Joseph, C.

    1981-01-01

    This paper describes a cost effective approach for inspections of Computerized Nuclear Materials Control and Accounting Systems (CNMCAS). Highlighted is the capability to conduct an inspection program via portable telephone terminals from off-site locations. The program can be applied to various materials management functions including materials control, quality assurance, and materials accounting. The system is designed to facilitate inspections by both external and internal groups

  12. The impact of cost recovery on electric utilities' Clean Air Act compliance strategies

    International Nuclear Information System (INIS)

    Bensinger, D.L.

    1993-01-01

    By 1995, over 200 electric power plant units in twenty one states must comply with Phase I of the acid rain requirements in Title IV of the 1990 Clean Air Act Amendments (CAAA). By the year 2000, an additional 2200 units must comply with the Title IV. Compliance costs are expected to necessitate significant electricity rate increases. In order to recover their compliance costs, utilities must file rate increase requests with state public utility commissions (PUC's), and undergo a rate proceeding involving public heatings. Because of the magnitude of cost and the complexity of compliance options, including interaction with Titles I and III of the CAAA, extensive PUC reviews of compliance strategies are likely. These reviews could become as adversarial as the nuclear prudence reviews of the 1980's. A lack of understanding of air pollution and the CAA by much of the general public and the flexibility of compliance options creates an environment conducive to adverse public reaction to the cost of complying with the Clean Air Act. Public attitudes toward pollution control technologies will be greatly affected by these hearings, and the early plant hearings will shape the utility rate making process under the Clean Air Act. Inadequate cost recovery due to constrained compliance strategies or adverse hearings could significantly inhibit industry willingness to invest in certain control technologies or advanced combustion technologies. There are already signs that Clean Air Act compliance will be the prudence issue of the 1990's for utilities, even where state statutes mandate particular compliance approaches. Specific actions should be undertaken now by the utility industry to improve the probability of sound cost recovery decisions, preserve compliance options, including multimedia strategies, and avoid the social- and cost-acceptance problems of nuclear power

  13. Costs and Cost-Effectiveness of Plasmodium vivax Control.

    Science.gov (United States)

    White, Michael T; Yeung, Shunmay; Patouillard, Edith; Cibulskis, Richard

    2016-12-28

    The continued success of efforts to reduce the global malaria burden will require sustained funding for interventions specifically targeting Plasmodium vivax The optimal use of limited financial resources necessitates cost and cost-effectiveness analyses of strategies for diagnosing and treating P. vivax and vector control tools. Herein, we review the existing published evidence on the costs and cost-effectiveness of interventions for controlling P. vivax, identifying nine studies focused on diagnosis and treatment and seven studies focused on vector control. Although many of the results from the much more extensive P. falciparum literature can be applied to P. vivax, it is not always possible to extrapolate results from P. falciparum-specific cost-effectiveness analyses. Notably, there is a need for additional studies to evaluate the potential cost-effectiveness of radical cure with primaquine for the prevention of P. vivax relapses with glucose-6-phosphate dehydrogenase testing. © The American Society of Tropical Medicine and Hygiene.

  14. 77 FR 58989 - Proposed CERCLA Administrative Cost Recovery Settlement for the Buckbee-Mears Co. Superfund Site...

    Science.gov (United States)

    2012-09-25

    ... paid $150,000 attributable to the costs of marketing and selling the Properties; (b) The Bank will pay... ENVIRONMENTAL PROTECTION AGENCY [FRL-9720-7] Proposed CERCLA Administrative Cost Recovery... costs concerning the Buckbee-Mears Co. Superfund Site located in Cortland, Cortland County, New York...

  15. Pursuing Photovoltaic Cost-Effectiveness

    DEFF Research Database (Denmark)

    Yang, Yongheng; Koutroulis, Eftichios; Sangwongwanich, Ariya

    2017-01-01

    loading of the power devices. However, its feasibility is challenged by the associated energy losses. An increase of the inverter lifetime and a reduction of the energy yield can alter the cost of energy, demanding an optimization of the power limitation. Therefore, aiming at minimizing the Levelized Cost...... be flexibly performed. As an advanced control strategy, the Absolute Active Power Control (AAPC) can effectively solve the overloading issues by limiting the maximum possible PV power to a certain level (i.e., the power limitation), and also benefit the inverter reliability due to the reduction in the thermal...... performance in terms of LCOE and energy production can be obtained by enabling the AAPC strategy, compared to the conventional PV inverter operating only in the maximum power point tracking mode. In the presented case study, the minimum of the LCOE is achieved for the PV system when the power limit...

  16. Cost-benefit analysis of copper recovery in remediation projects: A case study from Sweden.

    Science.gov (United States)

    Volchko, Yevheniya; Norrman, Jenny; Rosén, Lars; Karlfeldt Fedje, Karin

    2017-12-15

    Contamination resulting from past industrial activity is a problem throughout the world and many sites are severely contaminated by metals. Advances in research in recent years have resulted in the development of technologies for recovering metal from metal-rich materials within the framework of remediation projects. Using cost-benefit analysis (CBA), and explicitly taking uncertainties into account, this paper evaluates the potential social profitability of copper recovery as part of four remediation alternatives at a Swedish site. One alternative involves delivery of copper-rich ash to a metal production company for refining. The other three alternatives involve metal leaching from materials and sale of the resulting metal sludge for its further processing at a metal production company using metallurgical methods. All the alternatives are evaluated relative to the conventional excavation and disposal method. Metal recovery from the ash, metal sludge sale, and disposal of the contaminated soil and the ash residue at the local landfill site, was found to be the best remediation alternative. However, given the present conditions, its economic potential is low relative to the conventional excavation and disposal method but higher than direct disposal of the copper-rich ash for refining. Volatile copper prices, the high cost of processing equipment, the highly uncertain cost of the metal leaching and washing process, coupled with the substantial project risks, contribute most to the uncertainties in the CBA results for the alternatives involving metal leaching prior to refining. However, investment in processing equipment within the framework of a long-term investment project, production of safe, reusable soil residue, and higher copper prices on the metal market, can make metal recovery technology socially profitable. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. The effects of multiple anaesthetic episodes on equine recovery quality.

    Science.gov (United States)

    Platt, J P; Simon, B T; Coleman, M; Martinez, E A; Lepiz, M A; Watts, A E

    2018-01-01

    Although rare, 70% of equine fatalities during recovery from general anaesthesia (GA) are due to catastrophic fractures from poor recovery quality. To determine the effect of repeated GA recovery on GA recovery quality. Experimental blinded trial. Eight adult horses underwent six GA events on sevoflurane for distal limb MRI examination over a 14-week period. Prior to GA recovery, xylazine was administered. Randomly ordered video-recorded GA recoveries were scored by three blinded board certified veterinary anaesthesiologists, unaware of patient identity or GA event number, for nine parameters using a 100 mm visual analogue scale (VAS) where 0 = worst and 100 = best. The number of attempts to stand, duration of lateral and sternal recumbency, total recovery duration and physiologic parameters during each GA event were recorded. Repeated measures ANOVA were used to detect differences. Agreement between observer VAS scores was determined via inter-rater reliability using an intraclass correlation. With GA recovery experience, VAS scores for balance and coordination, knuckling, and overall quality of recovery were improved and the duration of lateral recumbency was increased. There were no differences in total recovery duration, number of attempts to stand, physiologic parameters other than heart rate during GA, or VAS scores for activity in lateral recumbency, move to sternal, move to stand, or strength. Each GA event was relatively short and there was no surgical stimulation. The same results may not occur if there was surgical stimulation and pain during each GA event. Recovery from GA improves with multiple anaesthetic episodes in horses. Clinicians can advise clients that horses are likely to have better GA recovery on repeated GA recovery due to improved balance and coordination and reduced knuckling. Additionally, there is no change in anaesthetic morbidity with six repeated GA events over a 14-week period. © 2017 EVJ Ltd.

  18. Effect of dose on creep and recovery of polyethylene

    Energy Technology Data Exchange (ETDEWEB)

    Novakovic, Lj; Gal, O; Charlesby, A; Stannett, V T

    1987-01-01

    The effect of high energy radiation on polyethylene is to crosslink it, and connect it into an elastic network above the melting point. In this paper the creep and recovery properties of a stabilized polyethylene subjected to doses from 100 to 870 kGy are measured at 150/sup 0/C. Two cycles are measured - Creep I + Recovery I, and Creep II + Recovery II -mainly over periods of 20 min. The creep or recovery behaviour falls into three steps - immediate, fast and slow, and data are given for these steps together with the time parameter. The first cycle includes a non-recoverable creep which is almost absent in the second cycle.

  19. Effect of dose on creep and recovery of polyethylene

    International Nuclear Information System (INIS)

    Novakovic, Lj.; Gal, O.; Charlesby, A.; Stannett, V.T.

    1987-01-01

    The effect of high energy radiation on polyethylene is to crosslink it, and connect it into an elastic network above the melting point. In this paper the creep and recovery properties of a stabilized polyethylene subjected to doses from 100 to 870 kGy are measured at 150 0 C. Two cycles are measured - Creep I + Recovery I, and Creep II + Recovery II -mainly over periods of 20 min. The creep or recovery behaviour falls into three steps - immediate, fast and slow, and data are given for these steps together with the time parameter. The first cycle includes a non-recoverable creep which is almost absent in the second cycle. (author)

  20. Costs and effects in lumbar spinal fusion

    DEFF Research Database (Denmark)

    Soegaard, Rikke; Christensen, Finn Bjarke; Christiansen, Terkel

    2007-01-01

    of the Dallas Pain Questionnaire and the Low Back Pain Rating Scale at baseline and 2 years postoperatively. Regression models were used to reveal determinants for costs and effects. Costs and effects were analyzed as a net-benefit measure to reveal determinants for cost-effectiveness, and finally, adjusted...... areas. Multi-level fusion and surgical technique significantly affected the net-benefit as well. Surprisingly, no correlation was found between treatment costs and treatment effects. Incremental analysis suggested that the probability of posterior instrumentation being cost-effective was limited......Although cost-effectiveness is becoming the foremost evaluative criterion within health service management of spine surgery, scientific knowledge about cost-patterns and cost-effectiveness is limited. The aims of this study were (1) to establish an activity-based method for costing at the patient...

  1. Review on dog rabies vaccination coverage in Africa: a question of dog accessibility or cost recovery?

    Science.gov (United States)

    Jibat, Tariku; Hogeveen, Henk; Mourits, Monique C M

    2015-02-01

    Rabies still poses a significant human health problem throughout most of Africa, where the majority of the human cases results from dog bites. Mass dog vaccination is considered to be the most effective method to prevent rabies in humans. Our objective was to systematically review research articles on dog rabies parenteral vaccination coverage in Africa in relation to dog accessibility and vaccination cost recovery arrangement (i.e.free of charge or owner charged). A systematic literature search was made in the databases of CAB abstracts (EBSCOhost and OvidSP), Scopus, Web of Science, PubMed, Medline (EBSCOhost and OvidSP) and AJOL (African Journal Online) for peer reviewed articles on 1) rabies control, 2) dog rabies vaccination coverage and 3) dog demography in Africa. Identified articles were subsequently screened and selected using predefined selection criteria like year of publication (viz. ≥ 1990), type of study (cross sectional), objective(s) of the study (i.e. vaccination coverage rates, dog demographics and financial arrangements of vaccination costs), language of publication (English) and geographical focus (Africa). The selection process resulted in sixteen peer reviewed articles which were used to review dog demography and dog ownership status, and dog rabies vaccination coverage throughout Africa. The main review findings indicate that 1) the majority (up to 98.1%) of dogs in African countries are owned (and as such accessible), 2) puppies younger than 3 months of age constitute a considerable proportion (up to 30%) of the dog population and 3) male dogs are dominating in numbers (up to 3.6 times the female dog population). Dog rabies parenteral vaccination coverage was compared between "free of charge" and "owner charged" vaccination schemes by the technique of Meta-analysis. Results indicate that the rabies vaccination coverage following a free of charge vaccination scheme (68%) is closer to the World Health Organization recommended coverage rate

  2. Costs, health effects and cost-effectiveness of alcohol and tobacco control strategies in Estonia.

    NARCIS (Netherlands)

    Lai, T.; Habicht, J.; Reinap, M.; Chisholm, D.; Baltussen, R.M.P.M.

    2007-01-01

    OBJECTIVE: To assess the population-level costs, effects and cost-effectiveness of different alcohol and tobacco control strategies in Estonia. DESIGN: A WHO cost-effectiveness modelling framework was used to estimate the total costs and effects of interventions. Costs were assessed in Estonian

  3. Customer complaints and recovery effectiveness : A customer base approach

    NARCIS (Netherlands)

    Knox, G.; van Oest, R.D.

    2014-01-01

    Although customer complaints are a well-studied aspect of business, no study has measured the impact of actual complaints and recoveries on subsequent customer purchasing. The authors develop a customer base model to investigate the effectiveness of recovery in preventing customer churn. They

  4. Recovery of Utility Fixed Costs: Utility, Consumer, Environmental and Economist Perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Wood, Lisa [Inst. for Electric Innovation and The Edison Foundation, Washington DC (United States); Hemphill, Ross [RCHemphill Solutions, Columbus, OH (United States); Howat, John [National Consumer Law Center, Boston, MA (United States); Cavanagh, Ralph [Natural Resources Defense Council, New York, NY (United States); Borenstein, Severin [Univ. of California, Berkeley, CA (United States); Deason, Jeff [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schwartz, Lisa [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Schwartz, Lisa [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-06-14

    Utilities recover costs for providing electric service to retail customers through a combination of rate components that together comprise customers’ monthly electric bills. Rates and rate designs are set by state regulators and vary by jurisdiction, utility and customer class. In addition to the fundamental tenet of setting fair and reasonable rates, rate design balances economic efficiency, equity and fairness, customer satisfaction, utility revenue stability, and customer price and bill stability.1 At the most basic level, retail electricity bills in the United States typically include a fixed monthly customer charge — a set dollar amount regardless of energy usage — and a volumetric energy charge for each kilowatt-hour consumed.2 The energy charge may be flat across all hours, vary by usage level (for example, higher rates at higher levels of usage), or vary based on time of consumption.3 While some utility costs, such as fuel costs, clearly vary according to electricity usage, other costs are “fixed” over the short run — generally, those that do not vary over the course of a year. Depending on your point of view, and whether the state’s electricity industry has been restructured or remains vertically integrated, the set of costs that are “fixed” may be quite limited. Or the set may extend to all capacity costs for generation, transmission and distribution. In the long run, all costs are variable. In the context of flat or declining loads in some regions, utilities are proposing a variety of changes to retail rate designs, particularly for residential customers, to recover fixed costs. In this report, authors representing utility (Chapter 1), consumer (Chapter 2), environmentalist (Chapter 3) and economist (Chapter 4) perspectives discuss fixed costs for electric utilities and set out their principles for recovering those costs. The table on the next page summarizes each author’s relative preferences for various options for fixed cost

  5. Guidance Document - Full-cost Recovery for Molybdenum-99 Irradiation Services: Methodology and Implementation

    International Nuclear Information System (INIS)

    Westmacott, Chad; Cameron, Ron

    2012-02-01

    At the request of its member countries, the OECD Nuclear Energy Agency (NEA) became involved in global efforts to ensure a reliable supply of molybdenum-99 ( 99 Mo) and its decay product, technetium-99m (' 99m Tc), the most widely used medical radioisotope. The NEA established the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) in 2009. Under its first mandate (June 2009-2011), the HLG-MR examined the major issues that affect the short-, medium- and long-term reliability of 99 Mo/' 99m Tc supply and then developed a policy approach to move the supply chain to a sustainable basis and ensure security of supply. The objectives of the HLG-MR during its second mandate (July 2011-2013) are to work towards increasing the long-term security of supply of 99 Mo and ' 99m Tc, especially through the implementation of the HLG-MR policy approach and its associated recommendations. This will entail actions to maintain transparency on global developments, continue communication with the supply chain and end users, evaluate progress toward implementation and provide additional information and analysis where necessary. A key action under the second mandate is to provide guidance on the implementation of the HLG-MR policy approach. This document provides guidance to reactor and alternative production technology (e.g., cyclotrons, accelerators) operators on how to undertake full-cost identification and implement full-cost recovery. The document also discusses issues related to levelling the playing field between old and new reactors. In order to move toward a long-term secure supply of 99 Mo and ' 99m Tc, the HLG-MR policy approach will need to be implemented by all countries that have an impact on the global market - as producers or consumers. A key recommendation of the policy approach is the implementation of full-cost identification and recovery by operators of 99 Mo-producing research reactors or alternative technologies. This document provides the

  6. Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.

    Science.gov (United States)

    Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R

    2013-10-01

    To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.

  7. Learning how to recover from job stress: effects of a recovery training program on recovery, recovery-related self-efficacy, and well-being.

    Science.gov (United States)

    Hahn, Verena C; Binnewies, Carmen; Sonnentag, Sabine; Mojza, Eva J

    2011-04-01

    This quasi-experimental study evaluated the effects of a recovery training program on recovery experiences (psychological detachment from work, relaxation, mastery experiences, and control during off-job time), recovery-related self-efficacy, and well-being outcomes. The training comprised two sessions held one week apart. Recovery experiences, recovery-related self-efficacy, and well-being outcomes were measured before the training (T1) and one week (T2) and three weeks (T3) after the training. A training group consisting of 48 individuals and a waitlist control group of 47 individuals were compared (N = 95). Analyses of covariance revealed an increase in recovery experiences at T2 and T3 (for mastery only at T2). Recovery-related self-efficacy and sleep quality increased at T2 and T3, perceived stress and state negative affect decreased at T3. No training effects were found for emotional exhaustion.

  8. Podoconiosis patients’ willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery

    Science.gov (United States)

    2014-01-01

    Background Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient’s willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia. Methods A cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n = 393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire. Results The majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP. Conclusions The considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government’s primary health care system. PMID:24642085

  9. CT colonography and cost-effectiveness

    Energy Technology Data Exchange (ETDEWEB)

    Mavranezouli, Ifigeneia [University College London, National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Sub-department of Clinical Health Psychology, London (United Kingdom); East, James E. [St Marks Hospital, Imperial College London, Wolfson Unit for Endoscopy, London (United Kingdom); Taylor, Stuart A. [University College Hospital, Specialist X-Ray, London (United Kingdom); University College Hospital, Department of Imaging, London (United Kingdom)

    2008-11-15

    CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)

  10. CT colonography and cost-effectiveness

    International Nuclear Information System (INIS)

    Mavranezouli, Ifigeneia; East, James E.; Taylor, Stuart A.

    2008-01-01

    CT colonography (CTC) is increasingly advocated as an effective initial screening tool for colorectal cancer. Nowadays, policy-makers are increasingly interested in cost-effectiveness issues. A number of studies assessing the cost-effectiveness of CTC have been published to date. The majority of findings indicate that CTC is probably not cost-effective when colonoscopy is available, but this conclusion is sensitive to a number of key parameters. This review discusses the findings of these studies, and considers those factors which most influence final conclusions, notably intervention costs, compliance rates, effectiveness of colonoscopy, and the assumed prevalence and natural history of diminutive advanced polyps. (orig.)

  11. Supplying synthetic crude oil from Canadian oil sands: A comparative study of the costs and CO2 emissions of mining and in-situ recovery

    International Nuclear Information System (INIS)

    Méjean, Aurélie; Hope, Chris

    2013-01-01

    High crude oil prices and the eventual decline of conventional oil production raise the issue of alternative fuels such as non-conventional oil. The paper describes a simple probabilistic model of the costs of synthetic crude oil produced from Canadian oil sands. Synthetic crude oil is obtained by upgrading bitumen that is first produced through mining or in-situ recovery techniques. This forward-looking analysis quantifies the effects of learning and production constraints on the costs of supplying synthetic crude oil. The sensitivity analysis shows that before 2035, the most influential parameters are the learning parameter in the case of in-situ bitumen and the depletion parameter in the case of mined bitumen. After 2035, depletion dominates in both cases. The results show that the social cost of CO 2 has a large impact on the total costs of synthetic crude oil, in particular in the case of synthetic crude oil from in-situ bitumen, due to the carbon intensity of the recovery techniques: taking into account the social cost of CO 2 adds more than half to the cost of producing synthetic crude oil from mined bitumen in 2050 (mean value), while the cost of producing synthetic crude oil from in-situ bitumen more than doubles. - Highlights: • We model the cost of Canadian synthetic crude oil (SCO) using Monte-Carlo techniques. • We reveal the uncertainty associated with each input parameter. • We quantify the effect of learning, depletion and CO 2 using sensitivity analyses. • Accounting for the social cost of CO 2 doubles the cost of SCO from in-situ bitumen. • CO 2 pricing could have a large effect on the economics of the oil sands

  12. Cost-effectiveness of monitoring free flaps.

    Science.gov (United States)

    Subramaniam, Shiva; Sharp, David; Jardim, Christopher; Batstone, Martin D

    2016-06-01

    Methods of free flap monitoring have become more sophisticated and expensive. This study aims to determine the cost of free flap monitoring and examine its cost effectiveness. We examined a group of patients who had had free flaps to the head and neck over a two-year period, and combined these results with costs obtained from business managers and staff. There were 132 free flaps with a success rate of 99%. The cost of monitoring was Aus $193/flap. Clinical monitoring during this time period cost Aus$25 476 and did not lead to the salvage of any free flaps. Cost equivalence is reached between monitoring and not monitoring only at a failure rate of 15.8%. This is to our knowledge the first study to calculate the cost of clinical monitoring of free flaps, and to examine its cost-effectiveness. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. All rights reserved.

  13. FIRM SIZE EFFECTS ON TRANSACTION COSTS

    NARCIS (Netherlands)

    NOOTEBOOM, B

    1993-01-01

    Associated with effects of scale, scope, experience and learning there are effects of firm size on transaction costs; in the stages of contact, contract and control. These effects are due to ''threshold costs'' in setting up contacts, contracts and governance schemes, and to differences with respect

  14. Biosimilar medicines and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Steven Simoens

    2011-02-01

    Full Text Available Steven SimoensResearch Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, BelgiumAbstract: Given that biosimilars are agents that are similar but not identical to the reference biopharmaceutical, this study aims to introduce and describe specific issues related to the economic evaluation of biosimilars by focusing on the relative costs, relative effectiveness, and cost-effectiveness of biosimilars. Economic evaluation assesses the cost-effectiveness of a medicine by comparing the costs and outcomes of a medicine with those of a relevant comparator. The assessment of cost-effectiveness of a biosimilar is complicated by the fact that evidence needed to obtain marketing authorization from a registration authority does not always correspond to the data requirements of a reimbursement authority. In particular, this relates to the availability of adequately powered equivalence or noninferiority studies, the need for comparative data about the effectiveness in a real-world setting rather than the efficacy in a structured setting, and the use of health outcome measures instead of surrogate endpoints. As a biosimilar is likely to be less expensive than the comparator (eg, the reference biopharmaceutical, the assessment of the cost-effectiveness of a biosimilar depends on the relative effectiveness. If appropriately designed and powered clinical studies demonstrate equivalent effectiveness between a biosimilar and the comparator, then a cost-minimization analysis identifies the least expensive medicine. If there are differences in the effectiveness of a biosimilar and the comparator, other techniques of economic evaluation need to be employed, such as cost-effectiveness analysis or cost-utility analysis. Given that there may be uncertainty surrounding the long-term safety (ie, risk of immunogenicity and rare adverse events and effectiveness of a biosimilar, the cost-effectiveness

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

    Science.gov (United States)

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

    2015-01-01

    The adoption of laparoscopy for distal pancreatectomy has proven to substantially improve short-term outcomes. Stress response after major surgery can be further minimized within an enhanced recovery programme (ERP). However, data on the potential benefit of an ERP for laparoscopic distal pancreatectomy are still lacking. The aim was to assess the feasibility, safety and cost of ERP for patients undergoing laparoscopic distal pancreatectomy. This is a case-control study from a Tertiary University Hospital. Sixty-six consecutive patients who underwent laparoscopic distal pancreatectomy were analyzed. Twenty-two patients were enrolled for the ERP and compared with previous consecutive 44 patients managed traditionally (1:2 ratio). Operative details, post-operative outcome and cost analysis were compared in the two groups. Patients enrolled in the ERP had similar intraoperative blood loss (median 165 ml vs. 200 ml; p = 0.176), operation time (225 min vs. 210 min; p = 0.633), time to remove naso-gastric tube (1 vs. 1 day; p = 0.081) but significantly shorter time to mobilization (median 1 vs. 2 days; p = 0.0001), start solid diet (2 vs. 3 days; p = 0004), and pass stools (3 vs. 5 days; p = 0.002) compared to the control group. Median length of stay was significantly shorter in the ERP group (3 vs. 6 days; p pancreatectomy with significant earlier return to normal gut function, reduced length of stay and cost saving. Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  16. Effect of illite clay and divalent cations on bitumen recovery

    Energy Technology Data Exchange (ETDEWEB)

    Ding, X. [SNC-Lavalin Inc., Calgary, AB (Canada); Repka, C. [Baker Petrolite Corp., Fort McMurray, AB (Canada); Xu, Z.; Masliyah, J. [Alberta Univ., Edmonton, AB (Canada). Dept. of Chemical and Materials Engineering

    2006-12-15

    Nearly 35 per cent of Canada's petroleum needs can be met from the Athabasca oil sands, particularly as conventional sources of petroleum decline. The interactions between bitumen and clay minerals play a key role in the recovery process of bitumen because they affect bitumen aeration. The 2 clays minerals found in various oil sands extraction process streams are kaolinite and illite. In this study, doping flotation tests using deionized water and electrokinetic studies were performed to examine the effect of illite clays on bitumen recovery. The effect of magnesium ions was also examined and compared with calcium ions. This paper also discussed the effects of temperature and tailings water chemistry. The negative effect of illite clay on bitumen recovery was found to be associated with its acidity. Denver flotation cell measurements indicated that the addition of calcium or magnesium ions to the flotation deionized water had only a slight effect on bitumen recovery, but the co-addition of illite clay and divalent cations resulted in a dramatic reduction in bitumen recovery. The effect was more significant at lower process temperature and low pH values. Zeta potential distributions of illite suspensions and bitumen emulsions were measured individually and as a mixture to determine the effect of divalent cations on the interaction between bitumen and illite clay. The presence of 1 mM calcium or magnesium ions in deionized water had a pronounced effect on the interactions between bitumen and illite clay. Slime coating of illite onto bitumen was not observed in zeta potential distribution measurements performed in alkaline tailings water. When tests were conducted using plant recycle water, the combination of illite clay and divalent cations did not have an adverse effect on bitumen recovery. 25 refs., 3 tabs., 15 figs.

  17. Cost-effectiveness thresholds: pros and cons.

    Science.gov (United States)

    Bertram, Melanie Y; Lauer, Jeremy A; De Joncheere, Kees; Edejer, Tessa; Hutubessy, Raymond; Kieny, Marie-Paule; Hill, Suzanne R

    2016-12-01

    Cost-effectiveness analysis is used to compare the costs and outcomes of alternative policy options. Each resulting cost-effectiveness ratio represents the magnitude of additional health gained per additional unit of resources spent. Cost-effectiveness thresholds allow cost-effectiveness ratios that represent good or very good value for money to be identified. In 2001, the World Health Organization's Commission on Macroeconomics in Health suggested cost-effectiveness thresholds based on multiples of a country's per-capita gross domestic product (GDP). In some contexts, in choosing which health interventions to fund and which not to fund, these thresholds have been used as decision rules. However, experience with the use of such GDP-based thresholds in decision-making processes at country level shows them to lack country specificity and this - in addition to uncertainty in the modelled cost-effectiveness ratios - can lead to the wrong decision on how to spend health-care resources. Cost-effectiveness information should be used alongside other considerations - e.g. budget impact and feasibility considerations - in a transparent decision-making process, rather than in isolation based on a single threshold value. Although cost-effectiveness ratios are undoubtedly informative in assessing value for money, countries should be encouraged to develop a context-specific process for decision-making that is supported by legislation, has stakeholder buy-in, for example the involvement of civil society organizations and patient groups, and is transparent, consistent and fair.

  18. [Cost-effectiveness of addiction care].

    Science.gov (United States)

    Suijkerbuijk, A W M; van Gils, P F; Greeven, P G J; de Wit, G A

    2015-01-01

    A large number of interventions are available for the treatment of addiction. Professionals need to know about the effectiveness and cost-effectiveness of interventions so they can prioritise appropriate interventions for the treatment of addiction. To provide an overview of the scientific literature on the cost-effectiveness of addiction treatment for alcohol- and drug-abusers. We searched the databases Medline and Centre for Reviews and Dissemination. To be relevant for our study, articles had to focus on interventions in the health-care setting, have a Western context and have a health-related outcome measure such as quality adjusted life years (QALY). Twenty-nine studies met our inclusion criteria: 15 for alcohol and 14 for drugs. The studies on alcohol addiction related mainly to brief interventions. They proved to be cost-saving or had a favourable incremental cost-effectiveness ratio (ICER), remaining below the threshold of € 20,000 per QALY. The studies on drug addiction all involved pharmacotherapeutic interventions. In the case of 10 out of 14 interventions, the ICER was less than € 20,000 per QALY. Almost all of the interventions studied were cost-saving or cost-effective. Many studies consider only health-care costs. Additional research, for instance using a social cost-benefit analysis, could provide more details about the costs of addiction and about the impact that an intervention could have in these/the costs.

  19. Cost-effectiveness Analysis for Technology Acquisition.

    Science.gov (United States)

    Chakravarty, A; Naware, S S

    2008-01-01

    In a developing country with limited resources, it is important to utilize the total cost visibility approach over the entire life-cycle of the technology and then analyse alternative options for acquiring technology. The present study analysed cost-effectiveness of an "In-house" magnetic resonance imaging (MRI) scan facility of a large service hospital against outsourcing possibilities. Cost per unit scan was calculated by operating costing method and break-even volume was calculated. Then life-cycle cost analysis was performed to enable total cost visibility of the MRI scan in both "In-house" and "outsourcing of facility" configuration. Finally, cost-effectiveness analysis was performed to identify the more acceptable decision option. Total cost for performing unit MRI scan was found to be Rs 3,875 for scans without contrast and Rs 4,129 with contrast. On life-cycle cost analysis, net present value (NPV) of the "In-house" configuration was found to be Rs-(4,09,06,265) while that of "outsourcing of facility" configuration was Rs-(5,70,23,315). Subsequently, cost-effectiveness analysis across eight Figures of Merit showed the "In-house" facility to be the more acceptable option for the system. Every decision for acquiring high-end technology must be subjected to life-cycle cost analysis.

  20. A Cost-Effectiveness Analysis for Incineration or Recycling of Dutch Household Plastics

    NARCIS (Netherlands)

    R.H.J.M. Gradus (Raymond); R. van Koppen (Rick); E. Dijkgraaf (Elbert); P. Nillesen (Paul)

    2016-01-01

    textabstractThe cost-effectiveness of plastic recycling is compared to energy recovery from plastic incineration in a waste-to-energy plant using data for the Netherlands. Both options have specific benefits and costs. The benefits of recycling are the avoidance of both CO2 that otherwise would be

  1. Recovery Risk and Labor Costs in Public-Private Partnerships : Contractual Choice in the US Water industry

    OpenAIRE

    Albalate, Daniel, 1980-; Bel i Queralt, Germà, 1963-; Geddes, R. Richard

    2012-01-01

    We use an ordered logistic model to empirically examine the factors that explain varying degrees of private involvement in the U.S. water sector through public-private partnerships. Our estimates suggest that a variety of factors help explain greater private participation in this sector. We find that the risk to private participants regarding cost recovery is an important driver of private participation. The relative cost of labor is also a key factor in determining the degree of private invo...

  2. Effects of Quebracho Tannin on Recovery of Colloidal Gold from ...

    African Journals Online (AJOL)

    This paper considered effects of Quebracho Tannin (QT) on recovery of gold from the oxidized flotation concentrate wash liquor. The effect of Quebracho Tannin on Total Suspended Solids (TSS) was also established. This research established that the gold lost to tailings was not soluble in the effluent but was mainly in the ...

  3. Review on Dog Rabies Vaccination Coverage in Africa: A Question of Dog Accessibility or Cost Recovery?

    NARCIS (Netherlands)

    Jibat, T.; Hogeveen, H.; Mourits, Monique C.M.

    2015-01-01

    Rabies is one of the most fatal diseases in both humans and animals. A bite by a rabid dog is the main cause of human rabies in Africa. Parenteral mass dog vaccination is the most cost-effective tool to prevent rabies in humans. Our main objective was to review research articles on the parenteral

  4. Gedanken Experiments in Educational Cost Effectiveness

    Science.gov (United States)

    Brudner, Harvey J.

    1978-01-01

    Discusses the effectiveness of cost determining techniques in education. The areas discussed are: education and management; cost-effectiveness models; figures of merit determination; and the implications as they relate to the areas of audio-visual and computer educational technology. (Author/GA)

  5. Tuition fees and sunk-cost effects

    NARCIS (Netherlands)

    Ketel, N.; Linde, J.; Oosterbeek, H.; van der Klaauw, B.

    2016-01-01

    This article reports on a field experiment testing for sunk-cost effects in an education setting. Students signing up for extra-curricular tutorial sessions randomly received a discount on the tuition fee. The sunk-cost effect predicts that students who pay more will attend more tutorial sessions,

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

    Directory of Open Access Journals (Sweden)

    Cheryl R Krull

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

  7. 76 FR 10028 - Settlement Agreement for Recovery of Past Response Costs 10,000 Havana Street Site, Commerce City...

    Science.gov (United States)

    2011-02-23

    ... ENVIRONMENTAL PROTECTION AGENCY [FRL-9269-7] Settlement Agreement for Recovery of Past Response Costs 10,000 Havana Street Site, Commerce City, Adams County, CO AGENCY: Environmental Protection Agency. ACTION: Notice and request for public comment. SUMMARY: In accordance with the requirements of Section...

  8. Benefits and costs of alcoholic relationships and recovery through Al-Anon.

    Science.gov (United States)

    Young, Lance Brendan; Timko, Christine

    2015-01-01

    Codependence is an ambiguous and disputed term often used to characterize both those who maintain relationships with alcoholics and those who seek help through resources such as Al-Anon Family Groups. The purpose of this article is to better understand non-pathological reasons for maintaining alcoholic relationships and for help-seeking by detailing the costs and benefits of those choices. The costs and benefits both of remaining in an alcoholic relationship and of seeking help in Al-Anon were identified through a review of available research on alcoholic family systems, Al-Anon, and other mutual-support groups. Alcoholic relationships may benefit concerned others by preserving self-identity, social identity, values, security, stability, and hope. Costs of alcoholic relationships include physical symptoms, injury, mental problems, financial difficulty, legal troubles, and relational distress. Al-Anon is perceived beneficial for six primary reasons: Al-Anon philosophy, format, social support, accessibility, effectiveness, and potential to change the drinker's behavior. Possible costs of Al-Anon include marginalization of the concerned other, blame, codependent pathology, sexist stereotyping, substitute dependency, and perpetuating victimization. Conclusions/Importance: The identified costs and benefits of alcoholic relationships and help-seeking in Al-Anon can help to model decision-making processes using existing behavioral health frameworks without defaulting to the stigmatized and ambiguous codependence terminology.

  9. THE EFFECT OF MASSAGE ON SOME RECOVERY PARAMETERS

    Directory of Open Access Journals (Sweden)

    Bilgehan Baydil

    2017-12-01

    Full Text Available The aim of this study was investigate the effect of total classic body massage on some recovery and circulation parameters. Fourteen non-athlete physically active male university students voluntarily participated in the study. Participants randomly divided into two group Massage Group (MG and Control Group (KG. All participants were informed about the purpose of the study, food consumption and not join the exercise before the test. 30 second Wingate Test protocol was used as exhaustive exercise. Heart Rate (KAH, systolic (SKB and diastolic (DKB blood pressures and blood lactate measured immediately after and 15 min recovery after exhaustive exercise. During 15 min recovery, total classic body massage was applied to MG group. Passive recovery was applied to KG group. The Shapiro Wilk Test of normality was used to determine if the data were normally distributed. Pair Sample T-Test was used for data’s were normally distributed, Wilcoxon Signed Ranks Test was used for data’s were not normally distributed. All analyses were set at p.05. Both groups blood lactate levels were significantly decreased (MG; t = 4.47, p = .004; KG; t = -2.36, p = .018. Blood lactate levels were determined as -51.60% and -24.63% on MG group and KG group respectively. Consequently, the total classic body massage thought to be effective on lactate removal level in short period of recovery.

  10. 76 FR 77528 - Proposed CERCLA Administrative Cost Recovery Settlement; North Hollywood Operable Unit of the San...

    Science.gov (United States)

    2011-12-13

    ...In accordance with Section 122(i) of the Comprehensive Environmental Response, Compensation, and Liability Act, as amended (``CERCLA''), 42 U.S.C. 9622(i), notice is hereby given of a proposed administrative settlement for recovery of response costs concerning the North Hollywood Operable Unit of the San Fernando Valley Area 1 Superfund Site, located in the vicinity of Los Angeles, California, with the following settling parties: Pick-Your-Part Auto Wrecking; Hayward Associates, LLC; and PNM Properties, LLC. The settlement requires the settling parties to pay a total of $102,161 to the North Hollywood Operable Unit Special Account within the Hazardous Substance Superfund. The settlement also includes a covenant not to sue the settling parties pursuant to Section 107(a) of CERCLA, 42 U.S.C. 9607(a). For thirty (30) days following the date of publication of this notice, the Agency will receive written comments relating to the settlement. The Agency will consider all comments received and may modify or withdraw its consent to the settlement if comments received disclose facts or considerations which indicate that the settlement is inappropriate, improper, or inadequate. The Agency's response to any comments received will be available for public inspection at the City of Los Angeles Central Library, Science and Technology Department, 630 West 5th Street, Los Angeles, CA 90071 and at the EPA Region 9 Superfund Records Center, Mail Stop SFD-7C, 95 Hawthorne Street, Room 403, San Francisco, CA 94105.

  11. 76 FR 79678 - Proposed CERCLA Administrative Cost Recovery Settlement; North Hollywood Operable Unit of the San...

    Science.gov (United States)

    2011-12-22

    ...In accordance with Section 122(i) of the Comprehensive Environmental Response, Compensation, and Liability Act, as amended (``CERCLA''), 42 U.S.C. 9622(i), notice is hereby given of a proposed administrative settlement for recovery of response costs concerning the North Hollywood Operable Unit of the San Fernando Valley Area 1 Superfund Site, located in the vicinity of Los Angeles, California, with the following settling parties: Pick-Your-Part Auto Wrecking; Hayward Associates, LLC; and PNM Properties, LLC. The settlement requires the settling parties to pay a total of $102,161 to the North Hollywood Operable Unit Special Account within the Hazardous Substance Superfund. The settlement also includes a covenant not to sue the settling parties pursuant to Section 107(a) of CERCLA, 42 U.S.C. 9607(a). For thirty (30) days following the date of publication of this notice, the Agency will receive written comments relating to the settlement. The Agency will consider all comments received and may modify or withdraw its consent to the settlement if comments received disclose facts or considerations which indicate that the settlement is inappropriate, improper, or inadequate. The Agency's response to any comments received will be available for public inspection at the City of Los Angeles Central Library, Science and Technology Department, 630 West 5th Street, Los Angeles, CA 90071 and at the EPA Region 9 Superfund Records Center, Mail Stop SFD-7C, 95 Hawthorne Street, Room 403, San Francisco, CA 94105.

  12. 77 FR 123 - Proposed CERCLA Administrative Cost Recovery Settlement; North Hollywood Operable Unit of the San...

    Science.gov (United States)

    2012-01-03

    ...In accordance with Section 122(i) of the Comprehensive Environmental Response, Compensation, and Liability Act, as amended (``CERCLA''), 42 U.S.C. 9622(i), notice is hereby given of a proposed administrative settlement for recovery of response costs concerning the North Hollywood Operable Unit of the San Fernando Valley Area 1 Superfund Site, located in the vicinity of Los Angeles, California, with the following settling party: Waste Management Recycling & Disposal Services of California, Inc., dba Bradley Landfill & Recycling Center. The settlement requires the settling party to pay a total of $185,734 to the North Hollywood Operable Unit Special Account within the Hazardous Substance Superfund. The settlement also includes a covenant not to sue the settling party pursuant to Section 107(a) of CERCLA, 42 U.S.C. 9607(a). For thirty (30) days following the date of publication of this notice, the Agency will receive written comments relating to the settlement. The Agency will consider all comments received and may modify or withdraw its consent to the settlement if comments received disclose facts or considerations which indicate that the settlement is inappropriate, improper, or inadequate. The Agency's response to any comments received will be available for public inspection at the City of Los Angeles Central Library, Science and Technology Department, 630 West 5th Street, Los Angeles CA 90071 and at the EPA Region 9 Superfund Records Center, Mail Stop SFD-7C, 95 Hawthorne Street, Room 403, San Francisco, CA 94105.

  13. Community financing of local ivermectin distribution in Nigeria: potential payment and cost-recovery outlook.

    Science.gov (United States)

    Onwujekwe, O E; Shu, E N; Okonkwo, P O

    2000-04-01

    The preferred payment mechanism in a community financing scheme for local ivermectin distribution was elicited from randomly selected household heads from three communities in Nigeria using interviewer-administered structured questionnaires. The majority of the respondents in the three communities were prepared to pay for local ivermectin distribution. Additionally, the average amounts the respondents were prepared to pay per person treated ($0.28, $0.30 and $0.38 in Nike, Achi and Toro, respectively) were all more than the $0.20 ceiling recommended by the partners of the African Programme on Onchocerciasis Control (APOC). Thus, the cost-recovery outlook is bright in these communities. However, the preferred payment modality varied. Fee-for-service was the predominant payment modality in the Achi and Nike communities, while the Toro community preferred pre-payment. This study demonstrates that many communities have different payment preferences for endemic disease control efforts. This knowledge will help in developing acceptable and sustainable schemes. The imposition of unacceptable payment mechanisms will lead to an unwillingness to pay.

  14. Cost effectiveness of radon mitigation in Canada

    International Nuclear Information System (INIS)

    Letourneau, E.G.; Krewski, D.; Zielinski, J.M.; McGregor, R.G.

    1992-01-01

    This paper examines the cost effectiveness of comprehensive strategies for reducing exposure to radon gas in indoor air in Canadian homes. The analysis is conducted within the context of a general framework for risk management programme evaluation which includes well-known evaluation techniques such as cost effectiveness and cost-benefit analyses as special cases. Based on this analysis, it is clear that any comprehensive programme to reduce exposure to environmental radon will be extremely expensive, and may not be justifiable in terms of health impact, particularly when considered in relation to other public health programmes. Testing of homes at the point of sale and installing sub-slab suction equipment to reduce exposure to indoor radon where necessary appears to be a relatively cost-effective radon mitigation strategy. In general, radon mitigation was found to be most cost effective in cities with relatively high levels of radon. (author)

  15. Influencing Factor of Postoperation Fast-track Recovery and in Hospital Cost after Lobctomy for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Jianhua SU

    2014-07-01

    Full Text Available Background and objective It is unknown that the postoperation fast-track recovery and in hospital cost of the lobectomy in lung cancer, we explored the influencing factor of postoperative fast-track recovery and in hospital cost after undergoing lobectomy for lung cancer. Methods We retrospectively reviewed the medical records of all patients (n=176 who underwent lobectomy for lung cancer between January 2010 and November 2011 by a thoracic surgeon. Results The hospital costs of video-assisted thoracic surgery (VATS lobectomy (47,308.21 ¥ is significantly higher than open lobectomy (45,664.31 ¥(P=0.007. The hospital costs of body mass index (BMI ≥ 24 kg/m2 (51,186.99 ¥ is significantly higher than BMI < 24 kg/m2 (41,701.64 ¥(P=0.032. The hospital stay of VATS lobectomy (5.70 d is significantly less than open lobectomy (7.10 d(P<0.001. Conclusion These findings indicate that preoperative pulmonary rehabilitation and VATS lobectomy is contributed to fast-track recovery for patients who undergo lobectomy, but increase the hospital costs.

  16. Storage duration effect on deformation recovery of repacked alginates

    Directory of Open Access Journals (Sweden)

    Siti Sunarintyas

    2009-09-01

    Full Text Available Background: Manufacturers supply alginate impression materials as a powder that is packaged in bulk and in individual container. Some Indonesian dental suppliers often repackage the bulk alginate into individual plastic packages which are not tied tightly and stored in the display room without air conditioner. It is known that critical factors to the shelf life of alginate includer avoidance of moisture contamination which may lead to premature setting of the alginate and avoidance of high temperature which may cause depolymerization of the alginate. Purpose: The aim of this study was to determine storage duration effect of repacked alginates on deformation recovery. Methods: Two brands of alginates (Tulip®TU, and Aroma Fine DF III®AF were repacked into 120 plastic containers. The samples were stored in room condition (temperature 29° C ± 1° C, relative humidity 60% ± 10% for 1, 2, 3, 4 and 5 weeks. The alginates setting time and recovery from deformation were measured according to the ANSI/ADA specification number 18 (ISO 1563. result: The results revealed that there was decreased setting time during 5 weeks but there was slight decreased in deformation recovery after 3 weeks storage. The ANOVA showed there was no significant difference of alginates deformation recovery among the storage times (p > 0.05. Conclusion: Storage duration of repacked alginates in plastic containers during 5 weeks in room condition do not influence the alginate deformation recovery.

  17. Recovery versus retest effects in attention after closed head injury

    NARCIS (Netherlands)

    Spikman, J.M.; Timmerman, M.E.; van Zomeren, A.H; Deelman, B.G.

    1999-01-01

    Recovery in 60 patients with a closed-head injury (CHI) in the first year posttrauma was assessed repeatedly with a series of attention tests. A matched group of healthy subjects was tested at the same intervals to allow us to control for practice effects. The results of a multilevel analysis for

  18. Low-cost carriers fare competition effect

    NARCIS (Netherlands)

    Carmona Benitez, R.B.; Lodewijks, G.

    2010-01-01

    This paper examines the effects that low-cost carriers (LCC’s) produce when entering new routes operated only by full-service carriers (FSC’s) and routes operated by low-cost carriers in competition with full-service carriers. A mathematical model has been developed to determine what routes should

  19. The Interpersonal Sunk-Cost Effect.

    Science.gov (United States)

    Olivola, Christopher Y

    2018-05-01

    The sunk-cost fallacy-pursuing an inferior alternative merely because we have previously invested significant, but nonrecoverable, resources in it-represents a striking violation of rational decision making. Whereas theoretical accounts and empirical examinations of the sunk-cost effect have generally been based on the assumption that it is a purely intrapersonal phenomenon (i.e., solely driven by one's own past investments), the present research demonstrates that it is also an interpersonal effect (i.e., people will alter their choices in response to other people's past investments). Across eight experiments ( N = 6,076) covering diverse scenarios, I documented sunk-cost effects when the costs are borne by someone other than the decision maker. Moreover, the interpersonal sunk-cost effect is not moderated by social closeness or whether other people observe their sunk costs being "honored." These findings uncover a previously undocumented bias, reveal that the sunk-cost effect is a much broader phenomenon than previously thought, and pose interesting challenges for existing accounts of this fascinating human tendency.

  20. The impact of consumer awareness of water sector issues on willingness to pay and cost recovery in Zambia

    Science.gov (United States)

    Ntengwe, F. W.

    The recovery of costs in water utilities is a key element in sustainability of both the provider and of the water resource itself. This paper examines the role played by consumer awareness in their willingness to pay for water supply in two cities in Zambia. Research conducted in Kitwe and Lusaka reveals that level of awareness, willingness to pay and cost recovery all vary directly. Whereas awareness may increase consumers’ willingness to pay, therefore assisting service provider’s cost recovery, the research presented here also reveals that factors such as ability to pay, affordability of bills, quality of water and of the service provided, as well as good business-consumer relations are important factors affecting a utility’s ability to recover its costs. If water utilities are to attain sustainability over the long-term, they will have to embark on and maintain consumer awareness programmes, raise the quality of service (e.g., through improved operation and maintenance), and develop and apply the right water tariff.

  1. Comparative Effects of Biomass Pre-Treatments for Direct and Indirect Transesterification to Enhance Microalgal Lipid Recovery

    International Nuclear Information System (INIS)

    Ghasemi Naghdi, Forough; Thomas-Hall, Skye R.; Durairatnam, Reuben; Pratt, Steven; Schenk, Peer M.

    2014-01-01

    Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME) recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however, FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane–ethanol (3:1). Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171%) under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min) in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

  2. Comparative effects of biomass pre-treatments for direct and indirect transesterification to enhance microalgal lipid recovery

    Directory of Open Access Journals (Sweden)

    Forough eGhasemi Naghdi

    2014-12-01

    Full Text Available Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane-ethanol (3:1. Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171% under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

  3. Comparative Effects of Biomass Pre-Treatments for Direct and Indirect Transesterification to Enhance Microalgal Lipid Recovery

    Energy Technology Data Exchange (ETDEWEB)

    Ghasemi Naghdi, Forough; Thomas-Hall, Skye R.; Durairatnam, Reuben [Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD (Australia); Pratt, Steven [School of Chemical Engineering, The University of Queensland, Brisbane, QLD (Australia); Schenk, Peer M., E-mail: p.schenk@uq.edu.au [Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD (Australia)

    2014-12-04

    Microalgal lipid recovery for biodiesel production is currently considered suboptimal, but pre-treatment of algal biomass, the use of solvent mixtures and the positioning of transesterification can lead to increased yields. Here, the effect of various reportedly successful pre-treatments and solvent mixtures were directly compared to each other and combined with direct and indirect transesterification methods using the oleaginous microalga Tetraselmis sp. M8. Microwave and thermal pre-treatments were applied and the total lipid and fatty acid methyl ester (FAME) recoveries were investigated. The application of pre-treatments increased FAME recovery through indirect transesterification when a Soxhlet system was used but they had no significant effect for direct transesterification. Gravimetric analyses of total lipids revealed that lipid recovery was highest when utilizing the chloroform-based Bligh and Dyer extraction method; however, FAME yield was the highest when applying a Soxhlet system utilizing a solvent mixture of hexane–ethanol (3:1). Total lipid recovery did not necessarily correlate with the recovery of FAMEs. The highest FAME recovery was achieved from thermal or microwave pre-treated biomass followed by indirect transesterification through Soxhlet extraction. FAME recovery could be more than doubled (increase of up to 171%) under these conditions. We conclude that a simple thermal pre-treatment (80°C for 10 min) in combination with solvent mixture extraction through indirect transesterification may present a cost-effective and scalable option for large-scale lipid extraction from microalgae.

  4. Green Infrastructure Siting and Cost Effectiveness Analysis

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Parcel scale green infrastructure siting and cost effectiveness analysis. You can find more details at the project's website.

  5. [Incremental cost effectiveness of multifocal cataract surgery].

    Science.gov (United States)

    Pagel, N; Dick, H B; Krummenauer, F

    2007-02-01

    Supplementation of cataract patients with multifocal intraocular lenses involves an additional financial investment when compared to the corresponding monofocal supplementation, which usually is not funded by German health care insurers. In the context of recent resource allocation discussions, however, the cost effectiveness of multifocal cataract surgery could become an important rationale. Therefore an evidence-based estimation of its cost effectiveness was carried out. Three independent meta-analyses were implemented to estimate the gain in uncorrected near visual acuity and best corrected visual acuity (vision lines) as well as the predictability (fraction of patients without need for reading aids) of multifocal supplementation. Study reports published between 1995 and 2004 (English or German language) were screened for appropriate key words. Meta effects in visual gain and predictability were estimated by means and standard deviations of the reported effect measures. Cost data were estimated by German DRG rates and individual lens costs; the cost effectiveness of multifocal cataract surgery was then computed in terms of its marginal cost effectiveness ratio (MCER) for each clinical benefit endpoint; the incremental costs of multifocal versus monofocal cataract surgery were further estimated by means of their respective incremental cost effectiveness ratio (ICER). An independent meta-analysis estimated the complication profiles to be expected after monofocal and multifocal cataract surgery in order to evaluate expectable complication-associated additional costs of both procedures; the marginal and incremental cost effectiveness estimates were adjusted accordingly. A sensitivity analysis comprised cost variations of +/- 10 % and utility variations alongside the meta effect estimate's 95 % confidence intervals. Total direct costs from the health care insurer's perspective were estimated 3363 euro, associated with a visual meta benefit in best corrected visual

  6. Cost competitive “soft sensor” for determining product recovery in industrial methanol

    DEFF Research Database (Denmark)

    S.B.A. Udugama, Isuru; Mansouri, Seyed Soheil; Huusom, Jakob Kjøbsted

    2017-01-01

    The measurement of ratio of product recovery in industrial methanol distillation is of high economic importance and represent a key performance index (KPI) of the distillation unit. In current operations, the product recovery of many industrial distillation units are not actively monitored, instead...

  7. Cost-effectiveness Analysis with Influence Diagrams.

    Science.gov (United States)

    Arias, M; Díez, F J

    2015-01-01

    Cost-effectiveness analysis (CEA) is used increasingly in medicine to determine whether the health benefit of an intervention is worth the economic cost. Decision trees, the standard decision modeling technique for non-temporal domains, can only perform CEA for very small problems. To develop a method for CEA in problems involving several dozen variables. We explain how to build influence diagrams (IDs) that explicitly represent cost and effectiveness. We propose an algorithm for evaluating cost-effectiveness IDs directly, i.e., without expanding an equivalent decision tree. The evaluation of an ID returns a set of intervals for the willingness to pay - separated by cost-effectiveness thresholds - and, for each interval, the cost, the effectiveness, and the optimal intervention. The algorithm that evaluates the ID directly is in general much more efficient than the brute-force method, which is in turn more efficient than the expansion of an equivalent decision tree. Using OpenMarkov, an open-source software tool that implements this algorithm, we have been able to perform CEAs on several IDs whose equivalent decision trees contain millions of branches. IDs can perform CEA on large problems that cannot be analyzed with decision trees.

  8. Cost and effectiveness of radon barrier systems

    International Nuclear Information System (INIS)

    Baker, E.G.; Freeman, H.D.; Hartley, J.N.; Gee, G.W.

    1982-12-01

    Earthen, asphalt, and multilayer radon barrier systems can all provide reduction in the amount of radon gas released from uranium mill tailings. Pacific Northwest Laboratory field tested all three types of covers at Grand Junction, Colorado during the summer of 1981. All nine individual radon barrier systems tested currently meet the EPA standard for radon flux of 20 pCi m - 2 s - 1 . The cost of the asphalt and 3m earthen covers were about the same at the field test. Multilayer covers were significantly more costly. Cost estimates for three high priority western sites indicate 3m of earthen cover is the least costly radon barrier when earthen material is available at or near the disposal site. If earthen material must be imported more than 8 to 10 km asphalt and possibly multilayer radon barriers can be cost effective

  9. Attentional demands and postural recovery: the effects of aging.

    Science.gov (United States)

    Brown, L A; Shumway-Cook, A; Woollacott, M H

    1999-04-01

    Cognitive demands associated with balance and locomotion may contribute to the incidence of falling among older adults. This study addressed issues related to the effects of aging on the attentional demands of recovering from an external disturbance to balance. This research also investigated whether performing a secondary cognitive task differentially affects postural recovery in young versus older adults. Fifteen young and 10 healthy older adults were exposed to a series of balance disturbances. Attentional demands were assessed using a dual task paradigm where postural recovery served as the primary task, and counting backwards served as a concurrent secondary cognitive task. The effect of the counting task was assessed by comparing kinematic variables related to feet-in-place and stepping recovery strategies. Recovering upright stance was found to be attentionally demanding in both age groups. The type of recovery strategy did not influence attentional demands in young adults; however, a hierarchy of increasing attentional demands between the ankle strategy and compensatory stepping was apparent among older adults. In addition, stepping appears to be more attentionally demanding for older adults than for younger adults. Counting backwards did not affect the type of strategy used; however, it did affect the kinematics of stepping. For both age groups, steps occurred when the center of mass was located in a more central location within the base of support when the secondary task was added. The ability to recover a stable posture following an external perturbation is more attentionally demanding for older adults than for younger adults. This would suggest that for some older adults, an increased risk for loss of balance and falls may result if sufficient attentional resources are not allocated to the task of postural recovery.

  10. Cost effectiveness of recycling: A systems model

    Energy Technology Data Exchange (ETDEWEB)

    Tonjes, David J., E-mail: david.tonjes@stonybrook.edu [Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY 11794-3560 (United States); Waste Reduction and Management Institute, School of Marine and Atmospheric Sciences, Stony Brook University, Stony Brook, NY 11794-5000 (United States); Center for Bioenergy Research and Development, Advanced Energy Research and Technology Center, Stony Brook University, 1000 Innovation Rd., Stony Brook, NY 11794-6044 (United States); Mallikarjun, Sreekanth, E-mail: sreekanth.mallikarjun@stonybrook.edu [Department of Technology and Society, College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, NY 11794-3560 (United States)

    2013-11-15

    Highlights: • Curbside collection of recyclables reduces overall system costs over a range of conditions. • When avoided costs for recyclables are large, even high collection costs are supported. • When avoided costs for recyclables are not great, there are reduced opportunities for savings. • For common waste compositions, maximizing curbside recyclables collection always saves money. - Abstract: Financial analytical models of waste management systems have often found that recycling costs exceed direct benefits, and in order to economically justify recycling activities, externalities such as household expenses or environmental impacts must be invoked. Certain more empirically based studies have also found that recycling is more expensive than disposal. Other work, both through models and surveys, have found differently. Here we present an empirical systems model, largely drawn from a suburban Long Island municipality. The model accounts for changes in distribution of effort as recycling tonnages displace disposal tonnages, and the seven different cases examined all show that curbside collection programs that manage up to between 31% and 37% of the waste stream should result in overall system savings. These savings accrue partially because of assumed cost differences in tip fees for recyclables and disposed wastes, and also because recycling can result in a more efficient, cost-effective collection program. These results imply that increases in recycling are justifiable due to cost-savings alone, not on more difficult to measure factors that may not impact program budgets.

  11. Deregulation and Nuclear Training: Cost Effective Alternatives

    International Nuclear Information System (INIS)

    Richard P. Coe; Patricia A. Lake

    2000-01-01

    Training is crucial to the success of any organization. It is also expensive, with some estimates exceeding $50 billion annually spent on training by U.S. corporations. Nuclear training, like that of many other highly technical organizations, is both crucial and costly. It is unlikely that the amount of training can be significantly reduced. If anything, current trends indicate that training needs will probably increase as the industry and workforce ages and changes. With the advent of energy deregulation in the United States, greater pressures will surface to make the costs of energy more cost-competitive. This in turn will drive businesses to more closely examine existing costs and find ways to do things in a more cost-effective way. The commercial nuclear industry will be no exception, and nuclear training will be equally affected. It is time for nuclear training and indeed the entire nuclear industry to begin using more aggressive techniques to reduce costs. This includes the need for nuclear training to find alternatives to traditional methods for the delivery of cost-effective high-quality training that meets regulatory requirements and produces well-qualified personnel capable of working in an efficient and safe manner. Computer-based and/or Web-based training are leading emerging technologies

  12. Recovery of Indirect Costs in the Pricing of Equitable Adjustments and Terminations for Convenience

    Science.gov (United States)

    1988-05-01

    HORNGREN , COST ACCOUNTING , A MANAGERIAL EMPHASIS, 21 (5th ed. 1982). 2 6FAR Part 31, Contract Cost Principles and Procedures. 2 7 L. ANDERSON...O WOIRECT COSTS /0 5. TYPE OF REPORT & PERIOD COVERED T$0, PEIK~ O ITPA3L-, AO s ~tjQr5 AfJI0 MS THESIS p O12T0MIPJTIOOZ P 0 o, CO V rJiC I rL)C .. S ... Accounting Standards (CAS) 13 C. The Cost Principles 14 D. Measurement of Cost 15 E. Accounting Systems 16 F. Allocation of Costs 17 1. Direct Costs

  13. How much are households willing to contribute to the cost recovery of drinking water supply? Results from a household survey

    Directory of Open Access Journals (Sweden)

    S. Tarfasa

    2013-04-01

    Full Text Available Financial resources are crucial to improve existing urban drinking water supply in developing countries typically characterized by low cost recovery rates and high and rapidly growing demand for more reliable services. This study examines the willingness to pay for improved urban drinking water supply employing a choice model (CM in an urban context in Ethiopia, Hawassa, with a household survey of 170 respondents. The design of the choice model allows the estimation of the values of two attributes of urban drinking water service (extra day water delivery per week and safer water. The findings indicate that households are willing to pay up to 60% extra for improved levels of water supply over and above their current water bill. Especially those households living in the poorest part of the city with the lowest service levels demonstrate that they are willing to pay more despite significant income constraints they are facing. Women value the improvement of water quality most, while a significant effect is found for averting behavior and expenditures. The estimated economic values can be used in policy appraisals of investment decisions.

  14. 24 CFR 266.656 - Recovery of costs after final claim settlement.

    Science.gov (United States)

    2010-04-01

    ... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS... project or otherwise, the total amount of such recovery shall be shared by HUD and the HFA in accordance...

  15. Is expanding Medicare coverage cost-effective?

    Directory of Open Access Journals (Sweden)

    Muennig Peter

    2005-03-01

    Full Text Available Abstract Background Proposals to expand Medicare coverage tend to be expensive, but the value of services purchased is not known. This study evaluates the efficiency of the average private supplemental insurance plan for Medicare recipients. Methods Data from the National Health Interview Survey, the National Death Index, and the Medical Expenditure Panel Survey were analyzed to estimate the costs, changes in life expectancy, and health-related quality of life gains associated with providing private supplemental insurance coverage for Medicare beneficiaries. Model inputs included socio-demographic, health, and health behavior characteristics. Parameter estimates from regression models were used to predict quality-adjusted life years (QALYs and costs associated with private supplemental insurance relative to Medicare only. Markov decision analysis modeling was then employed to calculate incremental cost-effectiveness ratios. Results Medicare supplemental insurance is associated with increased health care utilization, but the additional costs associated with this utilization are offset by gains in quality-adjusted life expectancy. The incremental cost-effectiveness of private supplemental insurance is approximately $24,000 per QALY gained relative to Medicare alone. Conclusion Supplemental insurance for Medicare beneficiaries is a good value, with an incremental cost-effectiveness ratio comparable to medical interventions commonly deemed worthwhile.

  16. Modeling the economic costs of disasters and recovery: analysis using a dynamic computable general equilibrium model

    Science.gov (United States)

    Xie, W.; Li, N.; Wu, J.-D.; Hao, X.-L.

    2014-04-01

    Disaster damages have negative effects on the economy, whereas reconstruction investment has positive effects. The aim of this study is to model economic causes of disasters and recovery involving the positive effects of reconstruction activities. Computable general equilibrium (CGE) model is a promising approach because it can incorporate these two kinds of shocks into a unified framework and furthermore avoid the double-counting problem. In order to factor both shocks into the CGE model, direct loss is set as the amount of capital stock reduced on the supply side of the economy; a portion of investments restores the capital stock in an existing period; an investment-driven dynamic model is formulated according to available reconstruction data, and the rest of a given country's saving is set as an endogenous variable to balance the fixed investment. The 2008 Wenchuan Earthquake is selected as a case study to illustrate the model, and three scenarios are constructed: S0 (no disaster occurs), S1 (disaster occurs with reconstruction investment) and S2 (disaster occurs without reconstruction investment). S0 is taken as business as usual, and the differences between S1 and S0 and that between S2 and S0 can be interpreted as economic losses including reconstruction and excluding reconstruction, respectively. The study showed that output from S1 is found to be closer to real data than that from S2. Economic loss under S2 is roughly 1.5 times that under S1. The gap in the economic aggregate between S1 and S0 is reduced to 3% at the end of government-led reconstruction activity, a level that should take another four years to achieve under S2.

  17. Spontaneous recovery of effects of contrast adaptation without awareness

    Directory of Open Access Journals (Sweden)

    Gaoxing eMei

    2015-09-01

    Full Text Available Prolonged exposure to a high contrast stimulus reduces the neural sensitivity to subsequent similar patterns. Recent work has disclosed that contrast adaptation is controlled by multiple mechanisms operating over differing timescales. Adaptation to high contrast for a relatively longer period can be rapidly eliminated by adaptation to a lower contrast (or meanfield in the present study. Such rapid deadaptation presumably causes a short-term mechanism to signal for a sensitivity increase, cancelling ongoing signals from long-term mechanisms. Once deadaptation ends, the short-term mechanism rapidly returns to baseline, and the slowly decaying effects in the long-term mechanisms reemerge, allowing the perceptual aftereffects to recover during continued testing. Although this spontaneous recovery effect is considered strong evidence supporting the multiple mechanisms theory, it remains controversial whether the effect is mainly driven by visual memory established during the initial longer-term adaptation period. To resolve this debate, we used a modified Continuous Flash Suppression (CFS and visual crowding paradigms to render the adapting stimuli invisible, but still observed the spontaneous recovery phenomenon. These results exclude the possibility that spontaneous recovery found in the previous work was merely the consequence of explicit visual memory. Our findings also demonstrate that contrast adaptation, even at the unconscious processing levels, is controlled by multiple mechanisms.

  18. Cost-effectiveness of colorectal cancer screening

    NARCIS (Netherlands)

    I. Lansdorp-Vogelaar (Iris); A.B. Knudsen (Amy); H. Brenner (Hermann)

    2011-01-01

    textabstractColorectal cancer is an important public health problem. Several screening methods have been shown to be effective in reducing colorectal cancer mortality. The objective of this review was to assess the cost-effectiveness of the different colorectal cancer screening methods and to

  19. Effect of Cytoflavin on Early Postanesthetic Recovery of Cancer Patients

    Directory of Open Access Journals (Sweden)

    K. F. Fatullayeva

    2008-01-01

    Full Text Available Objective: to evaluate the effect of the metabolic antihypoxant cytoflavin on the course of early postanesthetic recovery in patients operated on for various cancers. Subjects and methods: Fifty-seven patients aged 30 to 65 years, operated on for gynecological cancer, were examined. The patients were divided into 2 groups: 1 28 patients who took cytoflavin and 2 29 who did not. At the end of an operation, the agent was intravenously injected in a dose of 10 ml in a mixture with an equal volume of 0.9% sodium chloride solution. Thiopental sodium was used for initial anesthesia; arduan was employed to maintain muscle relaxation. Neuroleptic analgesia with fentanyl and droperidol or ataralgesia (fentanyl + relanium was applied in both groups. The levels of hemoglobin, glucose, sodium, potassium, calcium, malonic dialdehyde (MDA (Andreyev’s test, antioxidative activity (AOA (Semenov’s test were measured to evaluate the functional state of patients. The rating system for determining the recovery of consciousness, respiration, and motor activity, proposed by Aldret and Kroulik [8], and Bidway’s psychological testing, blood oxygen saturation and cardiac performance monitoring (TRITON, Russia and some others were used to evaluate the efficacy of the drug in the early postanesthetic period. The results were statistically processed using Microsoft Excel and a package of Biostatistics 6.0. Results. The use of cytoflavin at the end of surgery has been established to have a beneficial effect on the early recovery period. This is manifested as shorter recovery of consciousness and respiration mainly in the ataralgesia group; fair oxygen saturation, lower MDA concentrations and higher AOA are revealed. Conclusion. Cytoflavin significantly reduces the recovery of consciousness and adequate respiration and the incidence of the fever, muscle tremor syndrome and fails to favor the occurrence of hypoglycemia. Inclusion of cytoflavin into a complex of

  20. Life cycle cost of a hybrid forward osmosis – low pressure reverse osmosis system for seawater desalination and wastewater recovery

    KAUST Repository

    Valladares Linares, Rodrigo

    2015-10-19

    In recent years, forward osmosis (FO) hybrid membrane systems have been investigated as an alternative to conventional high-pressure membrane processes (i.e. reverse osmosis (RO)) for seawater desalination and wastewater treatment and recovery. Nevertheless, their economic advantage in comparison to conventional processes for seawater desalination and municipal wastewater treatment has not been clearly addressed. This work presents a detailed economic analysis on capital and operational expenses (CAPEX and OPEX) for: i) a hybrid forward osmosis – low-pressure reverse osmosis (FO-LPRO) process, ii) a conventional seawater reverse osmosis (SWRO) desalination process, and iii) a membrane bioreactor – reverse osmosis – advanced oxidation process (MBR-RO-AOP) for wastewater treatment and reuse. The most important variables affecting economic feasibility are obtained through a sensitivity analysis of a hybrid FO-LPRO system. The main parameters taken into account for the life cycle costs are the water quality characteristics (similar feed water and similar water produced), production capacity of 100,000 m3 d−1 of potable water, energy consumption, materials, maintenance, operation, RO and FO module costs, and chemicals. Compared to SWRO, the FO-LPRO systems have a 21% higher CAPEX and a 56% lower OPEX due to savings in energy consumption and fouling control. In terms of the total water cost per cubic meter of water produced, the hybrid FO-LPRO desalination system has a 16% cost reduction compared to the benchmark for desalination, mainly SWRO. Compared to the MBR-RO-AOP, the FO-LPRO systems have a 7% lower CAPEX and 9% higher OPEX, resulting in no significant cost reduction per m3 produced by FO-LPRO. Hybrid FO-LPRO membrane systems are shown to have an economic advantage compared to current available technology for desalination, and comparable costs with a wastewater treatment and recovery system. Based on development on FO membrane modules, packing density, and

  1. Cost-Effective Fuel Treatment Planning

    Science.gov (United States)

    Kreitler, J.; Thompson, M.; Vaillant, N.

    2014-12-01

    The cost of fighting large wildland fires in the western United States has grown dramatically over the past decade. This trend will likely continue with growth of the WUI into fire prone ecosystems, dangerous fuel conditions from decades of fire suppression, and a potentially increasing effect from prolonged drought and climate change. Fuel treatments are often considered the primary pre-fire mechanism to reduce the exposure of values at risk to wildland fire, and a growing suite of fire models and tools are employed to prioritize where treatments could mitigate wildland fire damages. Assessments using the likelihood and consequence of fire are critical because funds are insufficient to reduce risk on all lands needing treatment, therefore prioritization is required to maximize the effectiveness of fuel treatment budgets. Cost-effectiveness, doing the most good per dollar, would seem to be an important fuel treatment metric, yet studies or plans that prioritize fuel treatments using costs or cost-effectiveness measures are absent from the literature. Therefore, to explore the effect of using costs in fuel treatment planning we test four prioritization algorithms designed to reduce risk in a case study examining fuel treatments on the Sisters Ranger District of central Oregon. For benefits we model sediment retention and standing biomass, and measure the effectiveness of each algorithm by comparing the differences among treatment and no treat alternative scenarios. Our objective is to maximize the averted loss of net benefits subject to a representative fuel treatment budget. We model costs across the study landscape using the My Fuel Treatment Planner software, tree list data, local mill prices, and GIS-measured site characteristics. We use fire simulations to generate burn probabilities, and estimate fire intensity as conditional flame length at each pixel. Two prioritization algorithms target treatments based on cost-effectiveness and show improvements over those

  2. Effects of solutes on damage production and recovery in zirconium

    International Nuclear Information System (INIS)

    Zee, R.H.; Birtcher, R.C.; MacEwen, S.R.; Abromeit, C.

    1986-04-01

    Dilute zirconium-based alloys and pure zirconium were irradiated at 10 K with spallation neutrons at IPNS. Four types of alloys - Zr-Ti, Zr-Sn, Zr-Dy and Zr-Au - each with three concentration levels, were used. Low-temperature resistivity damage rates are enhanced by the presence of any of the four solutes. The greatest enhancement was produced by Au while the least by Dy. Within each alloy group, damage production also increased but at a decreasing rate, with increasing concentration. Post-irradiation annealing experiments, up to 400 K, showed that all four solutes suppress recovery due to interstitial migration, indicative of interstitial trapping by the solutes. Vacancy recovery is also suppressed by the presence of Sn, Dy or Au. The effect of Ti is to shift this stage to lower temperature. No clear correlation between the results with solute size was detected

  3. Prescribed burning cost recovery analysis on nonindustrial private forestland in North Carolina

    Science.gov (United States)

    Ronald J. Myers; William Powell; Mark Megalos

    2012-01-01

    A statewide internal analysis of prescribed burning costs was conducted by the North Carolina Division of Forest Resources (NCDFR) in 2008 to examine the regional differences of site preparation and silvicultural burning costs, and to determine which components were most responsible for losses or gains. This study analyzed actual costs for 90 site preparation (2,559...

  4. Some Observations on Cost-Effectiveness Analysis in Education.

    Science.gov (United States)

    Geske, Terry G.

    1979-01-01

    The general nature of cost-effectiveness analysis is discussed, analytical frameworks for conducting cost-effectiveness studies are described, and some of the problems inherent in measuring educational costs and in assessing program effectiveness are addressed. (Author/IRT)

  5. Treated Seawater as a Magnesium Source for Phosphorous Recovery from Wastewater—A Feasibility and Cost Analysis

    Directory of Open Access Journals (Sweden)

    Cejna Anna Quist-Jensen

    2016-12-01

    Full Text Available Conventional resources of phosphorous are at high risk of depletion in the near future due to current practices of its exploitation, thus new and improved exploration methodologies need to be developed to ensure phosphorous security. Today, some treatment plants recover phosphorous from municipal wastewater as struvite (MgNH4PO4·6H2O. Magnesium is often added to the wastewater as MgCl2·6H2O to facilitate the phosphorous recovery. However, the use of magnesium increases the costs of the process and is not aligned with sustainable development, therefore, alternative magnesium sources have to be found. The current study analyzes the feasibility of integrated membrane processes for magnesium recovery from seawater for utilization in the phosphorous recovery process. The integrated membrane systems consist of nanofiltration (NF, membrane distillation (MD, and membrane crystallization (MCr. The lowest associated cost is found for standalone NF treatment. However, the additional treatment with MD and MCr produces fresh water and salts like NaCl or potentially other valuable minerals at the expense of low-grade heat.

  6. Cost-effectiveness of tubal patency tests.

    Science.gov (United States)

    Verhoeve, H R; Moolenaar, L M; Hompes, P; van der Veen, F; Mol, B W J

    2013-04-01

    Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Cost-effectiveness analysis. Decision analytic framework. Computer-simulated cohort of subfertile women. We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. For a 30-year-old woman with otherwise unexplained subfertility for 12 months, 3-year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4, 5 and 6, respectively. The incremental cost-effectiveness ratios compared with scenario 1 (reference strategy), were €26,541, €19,046, €20,372, €20,150 and €23,184 for scenarios 2, 3, 4, 5 and 6, respectively. Sensitivity analysis showed the model to be robust over a wide range of values for the variables. The most cost-effective scenario is to perform no diagnostic tubal tests and to delay in vitro fertilisation (IVF) treatment for at least 12 months for women younger than 38 years old, and to perform no tubal tests and start immediate IVF treatment from the age of 39 years. If an invasive diagnostic test is planned, HSG followed by tailored treatment, or a DL if HSG shows no tubal patency, is more cost-effective than DL. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013

  7. Exploring the effects of ZVI addition on resource recovery in the anaerobic digestion process

    DEFF Research Database (Denmark)

    Puyol, D.; Flores-Alsina, Xavier; Segura, Y.

    2018-01-01

    not compensate the costs of ZVI purchase, and (b) ZVI dramatically decreases the P recovery potential in the digestate of the AD systems. This is the first study to experimentally and mathematically describe the effect of ZVI on biogas production/composition and on the fate of phosphorus compounds, and its......The influence of Zero Valent Iron (ZVI) addition on the potential resource recovery during the anaerobic digestion (AD) of domestic waste sludge is assessed. Potentially recoverable resources analyzed were nutrients such as struvite to recover P, and energy as biogas to recover C. Short term...... (biochemical methane potential tests, BMP) and long term (AD1, AD2) experiments are conducted using two types of set-up (batch, continuous). Process data (influent, effluent and biogas) is continuously collected and the dry digested sludge is analyzed by XPS. A mathematical model is developed based...

  8. Cost-effectiveness analysis and innovation.

    Science.gov (United States)

    Jena, Anupam B; Philipson, Tomas J

    2008-09-01

    While cost-effectiveness (CE) analysis has provided a guide to allocating often scarce resources spent on medical technologies, less emphasis has been placed on the effect of such criteria on the behavior of innovators who make health care technologies available in the first place. A better understanding of the link between innovation and cost-effectiveness analysis is particularly important given the large role of technological change in the growth in health care spending and the growing interest of explicit use of CE thresholds in leading technology adoption in several Westernized countries. We analyze CE analysis in a standard market context, and stress that a technology's cost-effectiveness is closely related to the consumer surplus it generates. Improved CE therefore often clashes with interventions to stimulate producer surplus, such as patents. We derive the inconsistency between technology adoption based on CE analysis and economic efficiency. Indeed, static efficiency, dynamic efficiency, and improved patient health may all be induced by the cost-effectiveness of the technology being at its worst level. As producer appropriation of the social surplus of an innovation is central to the dynamic efficiency that should guide CE adoption criteria, we exemplify how appropriation can be inferred from existing CE estimates. For an illustrative sample of technologies considered, we find that the median technology has an appropriation of about 15%. To the extent that such incentives are deemed either too low or too high compared to dynamically efficient levels, CE thresholds may be appropriately raised or lowered to improve dynamic efficiency.

  9. Milk: An Effective Recovery Drink for Female Athletes

    Directory of Open Access Journals (Sweden)

    Paula Rankin

    2018-02-01

    Full Text Available Milk has become a popular post-exercise recovery drink. Yet the evidence for its use in this regard comes from a limited number of investigations utilising very specific exercise protocols, and mostly with male participants. Therefore, the aim of this study was to investigate the effects of post-exercise milk consumption on recovery from a sprinting and jumping protocol in female team-sport athletes. Eighteen females participated in an independent-groups design. Upon completion of the protocol participants consumed 500 mL of milk (MILK or 500 mL of an energy-matched carbohydrate (CHO drink. Muscle function (peak torque, rate of force development (RFD, countermovement jump (CMJ, reactive strength index (RSI, sprint performance, muscle soreness and tiredness, symptoms of stress, serum creatine kinase (CK and high-sensitivity C-reactive protein (hsCRP were determined pre- and 24 h, 48 h and 72 h post-exercise. MILK had a very likely beneficial effect in attenuating losses in peak torque (180○/s from baseline to 72 h (0.0 ± 10.0% vs. −8.7 ± 3.7%, MILK v CHO, and countermovement jump (−1.1 ± 5.2% vs. −10.4 ± 6.7% and symptoms of stress (−13.5 ± 7.4% vs. −18.7 ± 11.0% from baseline to 24 h. MILK had a likely beneficial effect and a possibly beneficial effect on other peak torque measures and 5 m sprint performance at other timepoints but had an unclear effect on 10 and 20 m sprint performance, RSI, muscle soreness and tiredness, CK and hsCRP. In conclusion, consumption of 500 mL milk attenuated losses in muscle function following repeated sprinting and jumping and thus may be a valuable recovery intervention for female team-sport athletes following this type of exercise.

  10. Milk: An Effective Recovery Drink for Female Athletes.

    Science.gov (United States)

    Rankin, Paula; Landy, Adrian; Stevenson, Emma; Cockburn, Emma

    2018-02-17

    Milk has become a popular post-exercise recovery drink. Yet the evidence for its use in this regard comes from a limited number of investigations utilising very specific exercise protocols, and mostly with male participants. Therefore, the aim of this study was to investigate the effects of post-exercise milk consumption on recovery from a sprinting and jumping protocol in female team-sport athletes. Eighteen females participated in an independent-groups design. Upon completion of the protocol participants consumed 500 mL of milk (MILK) or 500 mL of an energy-matched carbohydrate (CHO) drink. Muscle function (peak torque, rate of force development (RFD), countermovement jump (CMJ), reactive strength index (RSI), sprint performance), muscle soreness and tiredness, symptoms of stress, serum creatine kinase (CK) and high-sensitivity C-reactive protein (hsCRP) were determined pre- and 24 h, 48 h and 72 h post-exercise. MILK had a very likely beneficial effect in attenuating losses in peak torque (180 ○ /s) from baseline to 72 h (0.0 ± 10.0% vs. -8.7 ± 3.7%, MILK v CHO), and countermovement jump (-1.1 ± 5.2% vs. -10.4 ± 6.7%) and symptoms of stress (-13.5 ± 7.4% vs. -18.7 ± 11.0%) from baseline to 24 h. MILK had a likely beneficial effect and a possibly beneficial effect on other peak torque measures and 5 m sprint performance at other timepoints but had an unclear effect on 10 and 20 m sprint performance, RSI, muscle soreness and tiredness, CK and hsCRP. In conclusion, consumption of 500 mL milk attenuated losses in muscle function following repeated sprinting and jumping and thus may be a valuable recovery intervention for female team-sport athletes following this type of exercise.

  11. The effect of sugammadex on postoperative cognitive function and recovery.

    Science.gov (United States)

    Pişkin, Özcan; Küçükosman, Gamze; Altun, Deniz Utku; Çimencan, Murat; Özen, Banu; Aydın, Bengü Gülhan; Okyay, Rahşan Dilek; Ayoğlu, Hilal; Turan, Işıl Özkoçak

    2016-01-01

    Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1h later the MoCA tests were repeated. Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p>0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (pSugammadex compared to the Neostigmine. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  12. The effect of sugammadex on postoperative cognitive function and recovery

    Directory of Open Access Journals (Sweden)

    Özcan Pişkin

    2016-08-01

    Full Text Available Abstract Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S or the Neostigmine group (Group N. The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA and Mini Mental State Examination (MMSE. After baseline assessment 12-24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05. The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p < 0.0001. Recovery time was 8.26 min in Group S and 16.93 min in Group N (p < 0.0001. Conclusion: We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.

  13. Making choices in health: WHO guide to cost effectiveness analysis

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . XXI PART ONE: METHODS COST-EFFECTIVENESS FOR GENERALIZED ANALYSIS 1. 2. What is Generalized Cost-Effectiveness Analysis? . . . . . . . . . . . . 3 Undertaking...

  14. The difference between energy consumption and energy cost: Modelling energy tariff structures for water resource recovery facilities.

    Science.gov (United States)

    Aymerich, I; Rieger, L; Sobhani, R; Rosso, D; Corominas, Ll

    2015-09-15

    The objective of this paper is to demonstrate the importance of incorporating more realistic energy cost models (based on current energy tariff structures) into existing water resource recovery facilities (WRRFs) process models when evaluating technologies and cost-saving control strategies. In this paper, we first introduce a systematic framework to model energy usage at WRRFs and a generalized structure to describe energy tariffs including the most common billing terms. Secondly, this paper introduces a detailed energy cost model based on a Spanish energy tariff structure coupled with a WRRF process model to evaluate several control strategies and provide insights into the selection of the contracted power structure. The results for a 1-year evaluation on a 115,000 population-equivalent WRRF showed monthly cost differences ranging from 7 to 30% when comparing the detailed energy cost model to an average energy price. The evaluation of different aeration control strategies also showed that using average energy prices and neglecting energy tariff structures may lead to biased conclusions when selecting operating strategies or comparing technologies or equipment. The proposed framework demonstrated that for cost minimization, control strategies should be paired with a specific optimal contracted power. Hence, the design of operational and control strategies must take into account the local energy tariff. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Cost Efficient Optimization Based Supervisory Controller for Supermarket Subsystems with Heat Recovery

    DEFF Research Database (Denmark)

    Minko, Tomasz; Wisniewski, Rafal; Bendtsen, Jan Dimon

    2015-01-01

    In this paper, we present a simple modelling approach for a thermal system, which consists of heating, ventilation, air conditioning system (HVAC) and a vapor compression cycle (VCC) system, with one loop heat recovery. In addition a simple model for water tank is presented, in which the reclaimed...

  16. 26 CFR 301.7430-2 - Requirements and procedures for recovery of reasonable administrative costs.

    Science.gov (United States)

    2010-04-01

    ... recovery—(1) Determination by the Internal Revenue Service. The Internal Revenue Service will grant a... such request is filed, the Internal Revenue Service's failure to respond may be considered by the..., the Internal Revenue Service will not grant a request for recovery of the reasonable administrative...

  17. 78 FR 74128 - Proposed CERCLA Administrative Cost Recovery Settlement; Cadie Auto Salvage Site, Belvidere...

    Science.gov (United States)

    2013-12-10

    ... Recovery Settlement; Cadie Auto Salvage Site, Belvidere, Boone County, Illinois AGENCY: Environmental... Auto Salvage Site in Belvidere, Boone County, Illinois with the following settling parties: UOP, LLC... Cadie Auto Salvage Site, Belvidere, Boone County, Illinois and EPA Docket No. and should be addressed to...

  18. 78 FR 77673 - Proposed CERCLA Administrative Cost Recovery Settlement; Cadie Auto Salvage Site, Belvidere...

    Science.gov (United States)

    2013-12-24

    ... Recovery Settlement; Cadie Auto Salvage Site, Belvidere, Boone County, Illinois AGENCY: Environmental... Auto Salvage Site in Belvidere, Boone County, Illinois with the following settling party: Helen E... reference the Cadie Auto Salvage Site, Belvidere, Boone County, Illinois and EPA Docket No. and should be...

  19. Effects of particle shape and size on nanofluid properties for potential Enhanced Oil Recovery (EOR

    Directory of Open Access Journals (Sweden)

    Tengku Mohd Tengku Amran

    2016-01-01

    Full Text Available Application of Enhanced Oil Recovery (EOR in oil and gas industry is very important to increase oil recovery and prolong the lifetime of a reservoir but it has been very costly and losing properties of EOR agent due to harsh condition. Nanoparticles have been used in EOR application since they are not degradable in reservoir condition and used in smaller amount compared to polymer usage. Commonly, EOR techniques are focusing on increasing the sweep efficiency by controlling the mobility ratio between reservoir fluid and injected fluid. Thus, this research aimed to analyze the nanofluid viscosity at different particle size and shape, volumetric concentration and types of dispersing fluid, as well as to determine the oil recovery performance at different nanofluid concentration. The nanofluid viscosity was investigated at nanoparticle sizes of 15nm and 60nm and shapes of 15nm spherical-solid and porous. Five nanofluid samples with concentration ranging from 0.1wt.% to 7wt.% were used to investigate the effect of volumetric concentration. Distilled water, ethanol, ethylene glycol (EG and brine were used for the effect of dispersing fluids. Oil recovery was investigated at five different concentrations of nanofluid samples through flooding test. It was found that viscosity of nanofluid increased with decreasing particle size and increasing volumetric concentration. Solid shape particle and increasing dispersing fluid viscosity resulted in higher nanofluid viscosity. The higher the nanofluid concentration, the higher the oil recovery obtained. It can be concluded that nanofluid properties have been significantly affected by the environment and the particle used for potential EOR application.

  20. 10 CFR 436.18 - Measuring cost-effectiveness.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Measuring cost-effectiveness. 436.18 Section 436.18 Energy... Procedures for Life Cycle Cost Analyses § 436.18 Measuring cost-effectiveness. (a) In accordance with this section, each Federal agency shall measure cost-effectiveness by combining cost data established under...

  1. 42 CFR 457.1015 - Cost-effectiveness.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this subpart... may demonstrate cost-effectiveness by comparing the cost of coverage for the family to the cost of...

  2. Integrating the Carbon and Water Footprints’ Costs in the Water Framework Directive 2000/60/EC Full Water Cost Recovery Concept: Basic Principles Towards Their Reliable Calculation and Socially Just Allocation

    Directory of Open Access Journals (Sweden)

    Anastasia Papadopoulou

    2012-01-01

    Full Text Available This paper presents the basic principles for the integration of the water and carbon footprints cost into the resource and environmental costs respectively, taking the suggestions set by the Water Framework Directive (WFD 2000/60/EC one step forward. WFD states that full water cost recovery (FWCR should be based on the estimation of the three sub-costs related: direct; environmental; and resource cost. It also strongly suggests the EU Member States develop and apply effective water pricing policies to achieve FWCR. These policies must be socially just to avoid any social injustice phenomena. This is a very delicate task to handle, especially within the fragile economic conditions that the EU is facing today. Water losses play a crucial role for the FWC estimation. Water losses should not be neglected since they are one of the major “water uses” in any water supply network. A methodology is suggested to reduce water losses and the related Non Revenue Water (NRW index. An Expert Decision Support System is proposed to assess the FWC incorporating the Water and Carbon Footprint costs.

  3. Steel impurity element effects on postirradiation properties recovery by annealing

    International Nuclear Information System (INIS)

    Hawthorne, J.R.

    1987-01-01

    The influence of copper content and phosphorus content on notch ductility recovery by 399 0 C postirradiation heat treatment was explored for A 533-B and A 302-B pressure vessel steels. Charpy-V (C/sub V/) specimens for the investigation were obtained from ten plates produced from four (4-way split) laboratory melts. The plates were 15.2 mm thick but were heat treated to reproduce the microstructure of 150-mm and thicker A 302-B plates at the quarter-thickness location. The C/sub V/ specimens were irradiated in two assemblies at 288 0 C (550 0 F) to a fluence of --2.5 x 10/sup 19/ n/cm/sup 2/ in a light-water-cooled and moderated test reactor. Notch ductility properties in the asirradiated and 399 0 C, 168 h postirradiation-annealed conditions were determined. In addition, separate sets of specimens were thermally conditioned at 288 0 C and at 288 0 C followed by 399 0 C to benchmark the effects of temperature in the absence of irradiation. The results indicate that copper has a significant influence on the magnitude of residual embrittlement after annealing. In contrast, phosphorus contents in the range of 0.002 to 0.025% were found not to have an effect on residual embrittlement either in high or low copper steels. Essentially full recovery in 41-J transition temperature was observed for high phosphorus, low copper content steels. Effects of nickel alloying on recovery behavior were also investigated through data comparisons for A 302-B versus A 533-B plates

  4. A cost effective CO2 strategy

    DEFF Research Database (Denmark)

    , a scenario-part and a cost-benefit part. Air and sea modes are not analyzed. The model adopts a bottom-up approach to allow a detailed assessment of transport policy measures. Four generic areas of intervention were identified and the likely effect on CO2 emissions, socioeconomic efficiency and other...... are evaluated according to CO2 reduction potential and according to the ‘shadow price’ on a reduction of one ton CO2. The shadow price reflects the costs (and benefits) of the different measures. Comparing the measures it is possible to identify cost effective measures, but these measures are not necessarily...... by the Ministry of Transport, with the Technical University of Denmark as one of the main contributors. The CO2-strategy was to be based on the principle of cost-effectiveness. A model was set up to assist in the assessment. The model consists of a projection of CO2-emissions from road and rail modes from 2020...

  5. Cost effectiveness of transportation fuels from biomass

    International Nuclear Information System (INIS)

    De Jager, D.; Faaij, A.P.C.; Troelstra, W.P.

    1998-06-01

    The aim of the study on the title subject was to investigate whether stimulation of the production and use of biofuels for transportation is worthwhile compared to the production of electricity from biomass. Several options are compared to each other and with reference technologies on the basis of the consumption or the avoided input of fossil fuels, emissions of greenhouse gases, specific costs and cost effectiveness. For each phase in the biomass conversion process (cultivation, pretreatment, transportation, conversion, distribution and final consumption) indicators were collected from the literature. Next to costs of the bioconversion routes attention is paid to other relevant aspects that are important for the introduction of the technological options in the Netherlands. 41 refs

  6. Clinical evaluation based on cost-effectiveness

    International Nuclear Information System (INIS)

    Inoue, Takehiro; Inoue, Toshihiko

    1998-01-01

    We carried out two Phase III clinical trials using high dose rate (HDR) remote afterloading brachytherapy unit. We evaluated the clinical results based not only on the medical but also the economical standpoint. The first trial is the Phase III trial for cervical cancer treated with HDR or medium dose rate (MDR) intracavitary radiotherapy. The second one is the Phase III trial for tongue cancer treated with HDR or low dose rate (LDR) interstitial radiation. For cervical cancer, the survival rate of patients treated with HDR brachytherapy is the some as for LDR brachytherapy. The average total cost of treatment for the HDR group was 1.47 million yen, while that for the MDR group was 1.58 million yen. The average total admission days was 63. For tongue cancer, the local control rate of the HDR group is almost the same as that of the LDR groups. The average total cost for the HDR group was 780 thousand yen, and that for the LDR group was 830 thousand yen. The average total admission days was 34. According to the cost-effectiveness, HDR brachytherapy for cervical cancer has the same result as MDR, and HDR brachytherapy for tongue cancer has the same result as LDR. However, HDR can be treated without admission for patients who live near the hospital. HDR can be applied for these patients with less expense. We must be aware of not only the medical results but also the cost-effectiveness. (author)

  7. The impact of cost recovery and sharing system on water policy implementation and human right to water: a case of Ileje, Tanzania.

    Science.gov (United States)

    Kibassa, Deusdedit

    2011-01-01

    In Tanzania, the National Water Policy (NAWAPO) of 2002 clearly stipulates that access to water supply and sanitation is a right for every Tanzanian and that cost recovery is the foundation of sustainable service delivery. To meet these demands, water authorities have introduced cost recovery and a water sharing system. The overall objective of this study was to assess the impact of cost recovery and the sharing system on water policy implementation and human rights to water in four villages in the Ileje district. The specific objectives were: (1) to assess the impact of cost recovery and the sharing system on the availability of water to the poor, (2) to assess user willingness to pay for the services provided, (3) to assess community understanding on the issue of water as a human right, (4) to analyse the implications of the results in relation to policies on human rights to water and the effectiveness of the implementation of the national water policy at the grassroots, and (5) to establish the guidelines for water pricing in rural areas. Questionnaires at water demand, water supply, ability and willingness to pay and revenue collection were the basis for data collection. While 36.7% of the population in the district had water supply coverage, more than 73,077 people of the total population of 115,996 still lacked access to clean and safe water and sanitation services in the Ileje district. The country's rural water supply coverage is 49%. Seventy-nine percent of the interviewees in all four villages said that water availability in litres per household per day had decreased mainly due to high water pricing which did not consider the income of villagers. On the other hand, more than 85% of the villagers were not satisfied with the amount they were paying because the services were still poor. On the issue of human rights to water, more than 92% of the villagers know about their right to water and want it exercised by the government. In all four villages, more than

  8. Cost effectiveness of surveillance for GI cancers.

    Science.gov (United States)

    Omidvari, Amir-Houshang; Meester, Reinier G S; Lansdorp-Vogelaar, Iris

    2016-12-01

    Gastrointestinal (GI) diseases are among the leading causes of death in the world. To reduce the burden of GI diseases, surveillance is recommended for some diseases, including for patients with inflammatory bowel diseases, Barrett's oesophagus, precancerous gastric lesions, colorectal adenoma, and pancreatic neoplasms. This review aims to provide an overview of the evidence on cost-effectiveness of surveillance of individuals with GI conditions predisposing them to cancer, specifically focussing on the aforementioned conditions. We searched the literature and reviewed 21 studies. Despite heterogeneity of studies in terms of settings, study populations, surveillance strategies and outcomes, most reviewed studies suggested at least some surveillance of patients with these GI conditions to be cost-effective. For some high-risk conditions frequent surveillance with 3-month intervals was warranted, while for other conditions, surveillance may only be cost-effective every 10 years. Further studies based on more robust effectiveness evidence are needed to inform and optimise surveillance programmes for GI cancers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Changes in transcription during recovery from heat injury in Salmonella typhimurium and effects of BCAA on recovery.

    Science.gov (United States)

    Hsu-Ming, Wen; Naito, Kimitaka; Kinoshita, Yoshimasa; Kobayashi, Hiroshi; Honjoh, Ken-ichi; Tashiro, Kousuke; Miyamoto, Takahisa

    2012-06-01

    Mechanisms of recovery from heat injury in Salmonella typhimurium were elucidated. Recovery of the heat-injured S. typhimurium cells in TSB resulted in full recovery after 3 h of incubation at 37°C. The DNA microarray analysis of 30- and 60-min recovering cells resulted in an increase in transcription of 89 and 141 genes, respectively. Among them, 15 genes, with known function, seemed to be somewhat involved in recovery. They encoded proteins involved in branched-chain amino acid (BCAA) transport (livJ, livH), cell envelope integrity (ddg), heat-shock response (cpxP, rrmJ), phage shock protein (pspA), ribosome modulation factor (rmf), virulence (sseB) transcriptional regulation (rpoE, rpoH, rseA, rseB, rseC) and ArcB signal transduction (sixA) and cytoplasmic membrane protein (fxsA). Among them, the effects of BCAA supplementation on recovery from heat injury were studied to confirm the importance of the BCAA transport liv genes during recovery. It was found that supplementation of TSB with 0.1% BCAA resulted in an enhanced recovery of injured cells in comparison to those recovered in TSB without BCAA. Supplementation of BCAA at 0.1% resulted in a cell count increase 4.4-fold greater than that of the control after 1 h incubation. It seems that BCAA promoted the recovery by promoting protein synthesis either directly through their use in translation or indirectly through stimulation of protein synthesis by activation of the Lrp protein.

  10. Making choices in health: WHO guide to cost effectiveness analysis

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6. Uncertainty in cost-effectiveness analysis . . . . . . . . . . . . . . . . . . 73 7. 8. Policy uses of Generalized CEA...

  11. Cost-effectiveness of the fenceline cow

    Energy Technology Data Exchange (ETDEWEB)

    Eichholz, G G; Lando, A V [Georgia Inst. of Tech., Atlanta (USA). School of Nuclear Engineering

    1979-07-01

    The grass-cow-milk pathway for /sup 131/I is one of the main contributers to estimated population dose from BWR's and PWR's. Such estimates assume a cow at the fenceline grazing for 12 months of the year. Reductions in the population dose would require a trade-off, based on cost-effectiveness criteria, between additions to the effluent treatment system, expanding the exclusion area, or raising the stack height. It is suggested that a more practical and more cost-effective means may be provided by redistribution of nearby dairy cattle (or goats), and that the plant operator buy these animals and/or contract with the land owner(s) to use the land for alternative crops. Even a subsidy to compensate the farmer for any financial losses entailed in these changes might be less expensive than alternative technical installations to lower iodine effluent levels. Figures are provided to illustrate these points.

  12. Preparation of recovery fuel - assumptions, quality, technology and cost; Upparbetning av returbraenslen - foerutsaettningar, kvalite, teknik och kostnader

    Energy Technology Data Exchange (ETDEWEB)

    Njurell, Rolf; Gyllenhammar, Marianne [SEP Scandinavian Energy Project AB, Goeteborg (Sweden)

    2000-05-01

    New laws and restrictions, in Sweden and within the EU, will change the handling of waste within the next years. The combustible wastes going to landfill today, have to be dealt with in another way in the future. The knowledge about fuel preparation has been accentuated. Preparation of wastes - properly executed - will make it a useful fuel and increase energy recovery. S.E.P. Scandinavian Energy Project AB has by the assignment of the Thermal Engineering Research Institute made this survey of required conditions technology and quality costs related to fuel preparation of recovered waste like wood, paper and plastic. Only a few fuel preparation plants for recovered waste exist in Sweden today. Most of the municipalities do not have any waste treatment except for landfill. In the future regional preparation plants will most likely be built. In that way recovered wastes can be treated in a cost-effective way and be converted into useful fuel. Transportation will increase when landfills, presently in use, will close and the waste has to be transported to regional plants. Recovered fuel can be divided into two types depending on their content. Recovered Wood Fuel is what we call RWF in this report. Recovered Commercial waste Fuel containing plastic, paper, textiles etc, is called RCF in this report. To receive a suitable fuel for a special combustion plant, the nature, quality and content of the fuel must be known. The choice of preparation equipment is guided both by the type of waste and the quality of fuel needed for the combustion plant. Different contaminations in waste are presented in the report, together with technology to separate them from the fuel. The report also focuses on some type of equipment that are available for fuel preparation in different applications. In general the waste has to be shredded or crushed and the tramp iron has to be removed. If required the waste also has to be screened. The non waste incineration plants firing RWF today and intend

  13. Life cycle cost of a hybrid forward osmosis - low pressure reverse osmosis system for seawater desalination and wastewater recovery.

    Science.gov (United States)

    Valladares Linares, R; Li, Z; Yangali-Quintanilla, V; Ghaffour, N; Amy, G; Leiknes, T; Vrouwenvelder, J S

    2016-01-01

    In recent years, forward osmosis (FO) hybrid membrane systems have been investigated as an alternative to conventional high-pressure membrane processes (i.e. reverse osmosis (RO)) for seawater desalination and wastewater treatment and recovery. Nevertheless, their economic advantage in comparison to conventional processes for seawater desalination and municipal wastewater treatment has not been clearly addressed. This work presents a detailed economic analysis on capital and operational expenses (CAPEX and OPEX) for: i) a hybrid forward osmosis - low-pressure reverse osmosis (FO-LPRO) process, ii) a conventional seawater reverse osmosis (SWRO) desalination process, and iii) a membrane bioreactor - reverse osmosis - advanced oxidation process (MBR-RO-AOP) for wastewater treatment and reuse. The most important variables affecting economic feasibility are obtained through a sensitivity analysis of a hybrid FO-LPRO system. The main parameters taken into account for the life cycle costs are the water quality characteristics (similar feed water and similar water produced), production capacity of 100,000 m(3) d(-1) of potable water, energy consumption, materials, maintenance, operation, RO and FO module costs, and chemicals. Compared to SWRO, the FO-LPRO systems have a 21% higher CAPEX and a 56% lower OPEX due to savings in energy consumption and fouling control. In terms of the total water cost per cubic meter of water produced, the hybrid FO-LPRO desalination system has a 16% cost reduction compared to the benchmark for desalination, mainly SWRO. Compared to the MBR-RO-AOP, the FO-LPRO systems have a 7% lower CAPEX and 9% higher OPEX, resulting in no significant cost reduction per m(3) produced by FO-LPRO. Hybrid FO-LPRO membrane systems are shown to have an economic advantage compared to current available technology for desalination, and comparable costs with a wastewater treatment and recovery system. Based on development on FO membrane modules, packing density, and

  14. Cost effects of hospital mergers in Portugal.

    Science.gov (United States)

    Azevedo, Helda; Mateus, Céu

    2014-12-01

    The Portuguese hospital sector has been restructured by wide-ranging hospital mergers, following a conviction among policy makers that bigger hospitals lead to lower average costs. Since the effects of mergers have not been systematically evaluated, the purpose of this article is to contribute to this area of knowledge by assessing potential economies of scale to explore and compare these results with realized cost savings after mergers. Considering the period 2003-2009, we estimate the translog cost function to examine economies of scale in the years preceding restructuring. Additionally, we use the difference-in-differences approach to evaluate hospital centres (HC) that occurred between 2004 and 2007, comparing the years after and before mergers. Our findings suggest that economies of scale are present in the pre-merger configuration with an optimum hospital size of around 230 beds. However, the mergers between two or more hospitals led to statistically significant post-merger cost increases, of about 8 %. This result indicates that some HC become too large to explore economies of scale and suggests the difficulty of achieving efficiencies through combining operations and service specialization.

  15. Longitudinal Recovery and Reduced Costs After 120 Sessions of Locomotor Training for Motor Incomplete Spinal Cord Injury.

    Science.gov (United States)

    Morrison, Sarah A; Lorenz, Douglas; Eskay, Carol P; Forrest, Gail F; Basso, D Michele

    2018-03-01

    To determine the impact of long-term, body weight-supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers. Prospective observational cohort with longitudinal follow-up. Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN). Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1-45y after SCI) who completed at least 120 NRN physical therapy sessions. Manually assisted locomotor training (LT) in a body weight-supported treadmill environment, overground standing and stepping activities, and community integration tasks. International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy. Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment. Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs. Copyright © 2018 American Congress of Rehabilitation Medicine

  16. Recovery Effect of the Muscle Fatigue by the Magnetic Stimulation

    Science.gov (United States)

    Uchida, Kousuke; Nuruki, Atsuo; Tsujimura, Sei-Ichi; Tamari, Youzou; Yunokuchi, Kazutomo

    The purpose of this study is to investigate the effect of magnetic stimulation for muscle fatigue. The six healthy subjects participated in the experiment with the repetition grasp using a hand dynamometer. The measurement of EMG (electromyography) and MMG (mechanomyography) is performed on the left forearm. All subjects performed MVC (maximum voluntary contraction), and repeated exercise in 80%MVC after the MVC measurement. The repetition task was entered when display muscular strength deteriorated. We used an EMG and MMG for the measurement of the muscle fatigue. Provided EMG and MMG waves were calculated integral calculus value (iEMG, and iMMG). The result of iEMG and iMMG were divided by muscular strength, because we calculate integral calculus value per the unit display muscular strength. The result of our study, we found recovery effect by the magnetic stimulation in voluntarily muscular strength and iEMG. However, we can not found in a figure of iMMG.

  17. Ventilation effectiveness : health benefits of heat recovery ventilators

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2010-08-15

    Studies have shown that the installation of a heat recovery ventilator (HRV) in homes in northern Canada could improve indoor air quality and the respiratory health of inhabitants. Low ventilation rates are common in many homes in the North because the climate is severe, homes are smaller and lack basements, and occupancies are higher, leading to unhealthy indoor air quality. Northern communities also have a high rate of respiratory infections. HRVs recover much of the energy used to ventilate, which is desirable in cold regions with high heating costs. For the study, the test sample was divided into two types of houses, notably houses with active HRVs and those with control HRVs that were installed and operated but that did not function. The study results showed that HRVs provided increased ventilation. Complaints by residents about HRV noise, discomfort, or low humidity were common but equally spread between those with active and placebo HRVs. The study showed that the system design needs to be improved to better suit the needs of Inuit families. The nature of northern housing presents installation and maintenance challenges. It is hard to retrofit HRV ducting inside small, existing houses, and building supplies arrive infrequently, so detailed planning and careful take-offs of all supplies and materials must be done well in advance of construction. In addition, contractors are hard to locate and have variable expertise, and there is little technical follow-up. Robust technical support by local contractors and housing authorities is therefore important. 2 refs.

  18. Development of More Effective Biosurfactants for Enhanced Oil Recovery/Advanced Recovery Concepts Awards; SEMIANNUAL

    International Nuclear Information System (INIS)

    McInerney, M.J.; Marsh, T.L.; Zhang, X.; Knapp, R.M.; Nagle, Jr. D.P.; Sharma, P.K.; Jackson, B.E.

    2002-01-01

    The objectives of this were two fold. First, core displacement studies were done to determine whether microbial processes could recover residual oil at elevated pressures. Second, the importance of biosurfactant production for the recovery of residual oil was studies. In these studies, a biosurfactant-producing, microorganisms called Bacillus licheniformis strain JF-2 was used. This bacterium produces a cyclic peptide biosurfactant that significantly reduces the interfacial tension between oil and brine (7). The use of a mutant deficient in surfactant production and a mathematical MEOR simulator were used to determine the major mechanisms of oil recovery by these two strains

  19. Development of More Effective Biosurfactants for Enhanced Oil Recovery/Advanced Recovery Concepts Awards

    Energy Technology Data Exchange (ETDEWEB)

    McInerney, M.J.; Marsh, T.L.; Zhang, X.; Knapp, R.M.; Nagle, Jr., D.P.; Sharma, P.K.; Jackson, B.E.

    2002-05-28

    The objectives of this were two fold. First, core displacement studies were done to determine whether microbial processes could recover residual oil at elevated pressures. Second, the importance of biosurfactant production for the recovery of residual oil was studies. In these studies, a biosurfactant-producing, microorganisms called Bacillus licheniformis strain JF-2 was used. This bacterium produces a cyclic peptide biosurfactant that significantly reduces the interfacial tension between oil and brine (7). The use of a mutant deficient in surfactant production and a mathematical MEOR simulator were used to determine the major mechanisms of oil recovery by these two strains.

  20. On cost-effective communication network designing

    Science.gov (United States)

    Zhang, Guo-Qiang

    2010-02-01

    How to efficiently design a communication network is a paramount task for network designing and engineering. It is, however, not a single objective optimization process as perceived by most previous researches, i.e., to maximize its transmission capacity, but a multi-objective optimization process, with lowering its cost to be another important objective. These two objectives are often contradictive in that optimizing one objective may deteriorate the other. After a deep investigation of the impact that network topology, node capability scheme and routing algorithm as well as their interplays have on the two objectives, this letter presents a systematic approach to achieve a cost-effective design by carefully choosing the three designing aspects. Only when routing algorithm and node capability scheme are elegantly chosen can BA-like scale-free networks have the potential of achieving good tradeoff between the two objectives. Random networks, on the other hand, have the built-in character for a cost-effective design, especially when other aspects cannot be determined beforehand.

  1. 49 CFR 639.21 - Determination of cost-effectiveness.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Determination of cost-effectiveness. 639.21... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Cost-Effectiveness § 639.21 Determination of cost...-effectiveness comparison as described in this subpart, it may ask FTA to approve an alternate form of cost...

  2. Custom LSI plus hybrid equals cost effectiveness

    Science.gov (United States)

    Friedman, S. N.

    The possibility to combine various technologies, such as Bi-Polar linear and CMOS/Digital makes it feasible to create systems with a tailored performance not available on a single monolithic circuit. The custom LSI 'BLOCK', especially if it is universal in nature, is proving to be a cost effective way for the developer to improve his product. The custom LSI represents a low price part in contrast to the discrete components it will replace. In addition, the hybrid assembly can realize a savings in labor as a result of the reduced parts handling and associated wire bonds. The possibility of the use of automated system manufacturing techniques leads to greater reliability as the human factor is partly eliminated. Attention is given to reliability predictions, cost considerations, and a product comparison study.

  3. Cost effects of Cu powder and bentonite on the disposal costs of an HLW repository in

    International Nuclear Information System (INIS)

    Kim, Sung Ki; Lee, Min Soo; Lee, Jong Youl; Choi, Heui Joo; Choi, Jong Won

    2008-01-01

    This paper provides the cost effect results of Cu powder and bentonite on the disposal cost for an HLW repository in Korea. In the cost analysis for both of these cost drivers, the price of Cu powder and the bentonite can affect the canister cost and the bentonite cost of the disposal holes as well as backfilling cost of the tunnels, respectively. Finally, we found that the unit cost of Cu and bentonite was the dominant cost drivers for the surface and underground facilities of an HLW repository. Therefore, an optimization of a canister and the layout of a disposal hole and disposal tunnels are essential to decrease the direct disposal cost of spent fuels. The disposal costs can be largely divided into two parts such as a surface facilities' cost and an underground facilities' cost. According to the KRS' cost analysis, the encapsulation material as well as the buffering and backfilling cost were the significant costs. Especially, a canister's cost was approximately estimated to be more than one fourth of the overall disposal costs. So it can be estimated that the unit cost of Cu powder is an important cost diver. Because the outer shell of the canister was made of Cu powder by a cold spray coating method. In addition, the unit cost of bentonite can also affect the buffering and the backfilling costs of the disposal holes and the disposal tunnels. But, these material costs will be highly expensive and unstable due to the modernization of the developing countries. So the studies for a material cost should be continued to identify the actual cost of an HLW repository

  4. Aid Effectiveness, Transaction Costs and Conditionality in the Education Sector

    Science.gov (United States)

    Ashford, Richard; Biswas, Shampa

    2010-01-01

    The reduction of transaction costs is a commonly mentioned yet rarely elaborated goal for aid effectiveness in educational development. The casual use of the concept of transaction costs conceals which costs may be reduced, which costs are required and, indeed, what transaction costs actually are. Examining issues related to harmonizing the…

  5. Report: EPA Needs to Improve Internal Controls to Increase Cost Recovery

    Science.gov (United States)

    Report #09-P-0144, April 27, 2009. Within a sample of removal actions we reviewed, EPA collected from responsible parties approximately 11 percent ($31.4 of $294.5 million) of the Federal Government’s costs for conducting the removal actions.

  6. 76 FR 64943 - Proposed Cercla Administrative Cost Recovery Settlement; ACM Smelter and Refinery Site, Located...

    Science.gov (United States)

    2011-10-19

    ... Settlement; ACM Smelter and Refinery Site, Located in Cascade County, MT AGENCY: Environmental Protection... projected future response costs concerning the ACM Smelter and Refinery NPL Site (Site), Operable Unit 1..., Helena, MT 59626. Mr. Sturn can be reached at (406) 457-5027. Comments should reference the ACM Smelter...

  7. 76 FR 51029 - Proposed CERCLA Administrative Cost Recovery Settlement; Carpenter Avenue Mercury Site, Iron...

    Science.gov (United States)

    2011-08-17

    ... Settlement; Carpenter Avenue Mercury Site, Iron Mountain, Dickenson County, MI AGENCY: Environmental... of past response costs concerning the Carpenter Avenue Mercury site in Iron Mountain, Dickenson...., mail code: C-14J, Chicago, Illinois 60604. Comments should reference the Carpenter Avenue Mercury site...

  8. 76 FR 71342 - Proposed CERCLA Administrative Cost Recovery Settlement; River Forest Dry Cleaners Site, River...

    Science.gov (United States)

    2011-11-17

    ... Settlement; River Forest Dry Cleaners Site, River Forest, Cook County, IL AGENCY: Environmental Protection... response costs concerning the River Forest Dry Cleaners site in River Forest, Cook County, Illinois with... code: C-14J, Chicago, Illinois 60604. Comments should reference the River Forest Dry Cleaners Site...

  9. 75 FR 34448 - Proposed CERCLA Administrative Cost Recovery Settlement; Great Lakes Container Corporation...

    Science.gov (United States)

    2010-06-17

    ... Settlement; Great Lakes Container Corporation Superfund Site, Coventry Rhode Island AGENCY: Environmental... and future response costs concerning the Great Lakes Container Corporation Superfund Site, located in...), Boston, MA 02109-3912, (617) 918-1216. Comments should reference the Great Lakes Container Corporation...

  10. Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment.

    Directory of Open Access Journals (Sweden)

    Smita Nayak

    Full Text Available Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women.Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA, and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of $20 through $800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs; and incremental cost-effectiveness ratios (ICERs in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed.Base-case analysis results showed that at annual alendronate costs of $200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days. When assuming alendronate costs of $400 through $800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from $714 per QALY gained through $13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of $50,000/QALY at all alendronate costs evaluated.Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost

  11. Greenhouse effect reduction and energy recovery from waste landfill

    Energy Technology Data Exchange (ETDEWEB)

    Lombardi, Lidia [Dipartimento di Energetica ' Sergio Stecco' , Universita degli Studi di Firenze, Via Santa Marta 3, 50139 Florence (Italy)]. E-mail: lidia.lombardi@pin.unifi.it; Carnevale, Ennio [Dipartimento di Energetica ' Sergio Stecco' , Universita degli Studi di Firenze, Via Santa Marta 3, 50139 Florence (Italy); Corti, Andrea [Dipartimento di Ingegneria dell' Informazione, Universita degli Studi di Siena, Via Roma 56, 53100 Siena (Italy)

    2006-12-15

    Waste management systems are a non-negligible source of greenhouse gases. In particular, methane and carbon dioxide emissions occur in landfills due to the breakdown of biodegradable carbon compounds operated on by anaerobic bacteria. The conventional possibilities of reducing the greenhouse effect (GHE) from waste landfilling consists in landfill gas (LFG) flaring or combustion with energy recovery in reciprocating engines. These conventional treatments are compared with three innovative possibilities: the direct LFG feeding to a fuel cell (FC); the production of a hydrogen-rich gas, by means of steam reforming and CO{sub 2} capture, to feed a stationary FC; the production of a hydrogen-rich gas, by means of steam reforming and CO{sub 2} capture, to feed a vehicle FC. The comparison is carried out from an environmental point of view, calculating the specific production of GHE per unit mass of waste disposed in landfill equipped with the different considered technologies.

  12. How rebates, copayments, and administration costs affect the cost-effectiveness of osteoporosis therapies.

    Science.gov (United States)

    Ferko, Nicole C; Borisova, Natalie; Airia, Parisa; Grima, Daniel T; Thompson, Melissa F

    2012-11-01

    Because of rising drug expenditures, cost considerations have become essential, necessitating the requirement for cost-effectiveness analyses for managed care organizations (MCOs). The study objective is to examine the impact of various drug-cost components, in addition to wholesale acquisition cost (WAC), on the cost-effectiveness of osteoporosis therapies. A Markov model of osteoporosis was used to exemplify different drug cost scenarios. We examined the effect of varying rebates for oral bisphosphonates--risedronate and ibandronate--as well as considering the impact of varying copayments and administration costs for intravenous zoledronate. The population modeled was 1,000 American women, > or = 50 years with osteoporosis. Patients were followed for 1 year to reflect an annual budget review of formularies by MCOs. The cost of therapy was based on an adjusted WAC, and is referred to as net drug cost. The total annual cost incurred by an MCO for each drug regimen was calculated using the net drug cost and fracture cost. We estimated cost on a quality adjusted life year (QALY) basis. When considering different rebates, results for risedronate versus ibandronate vary from cost-savings (i.e., costs less and more effective) to approximately $70,000 per QALY. With no risedronate rebate, an ibandronate rebate of approximately 65% is required before cost per QALY surpasses $50,000. With rebates greater than 25% for risedronate, irrespective of ibandronate rebates, results become cost-saving. Results also showed the magnitude of cost savings to the MCO varied by as much as 65% when considering no administration cost and the highest coinsurance rate for zoledronate. Our study showed that cost-effectiveness varies considerably when factors in addition to the WAC are considered. This paper provides recommendations for pharmaceutical manufacturers and MCOs when developing and interpreting such analyses.

  13. Training effectiveness vs. cost effectiveness: The next millennium challenge

    International Nuclear Information System (INIS)

    Coe, Richard P.

    2003-01-01

    With the advent of the new millennium and energy deregulation, organizations will be challenged to be cost competitive and profitable. Deregulation in the US energy industry will force utilities and, more specifically, commercial nuclear power production to unprecedented cost control measures. It will also renew the fires of debate about costs vs. safety. With personnel costs being the single largest expenditure for most organizations management will be faced with constant dilemmas of competition for scarce resources. Salaries, benefits and training costs will be under greater scrutiny. Training resources and programs will face increased pressure to be job related, based on conservative requirements and more cost effective than in the past. For nearly two decades the US National Academy for Nuclear Training (NANT) has developed and used industry-wide accreditation and evaluation standards based on the Systematic Approach to Training (SAT). This process assures that existing and emerging technical training is constantly reviewed and evaluated against standardized criteria to assure job relatedness and enhanced job performance. The process also requires management to approve, actively participate in and support the training of NPP personnel. Instructors must be highly skilled and well trained in the SAT process and various instructional strategies. The SAT process is grounded in five interlocking keystone steps; Analysis - Design - Development - Implementation - Evaluation (ADDIE). Evaluation of training is often said to be the most crucial and most difficult step. Here is where an organization determines if the training is effective and meeting the legitimate needs of all of the stakeholders. This QA/QC aspect of training must be an ongoing process involving management, instructors and the students. It is only through the discipline of an SAT based evaluation process that an organization can truly determine if the training is efficient, effective, cost effective and

  14. Cost effective material control and accountability training

    International Nuclear Information System (INIS)

    Robichaux, J.J.; Shull, L.M.; Salizzoni, L.M.

    1995-01-01

    DOE Order 5630.15, ''Safeguards and Security Training Program'' is being implemented at the Savannah River Site within the Westinghouse Savannah River Company's material control and accountability program. This paper reviews the development of a material control and accountability task analysis, the development of specific material control and accountability courses, and the cost effective and innovative strategies employed to implement the training program. The paper also discusses how the site material control and accountability policies and procedures are incorporated into the Westinghouse Savannah River Company training program to ensure that personnel receive the most current information

  15. From Consumption to Prosumption - Operational Cost Optimization for Refrigeration System With Heat Waste Recovery

    DEFF Research Database (Denmark)

    Minko, Tomasz; Garcia, Jesus Lago; Bendtsen, Jan Dimon

    2017-01-01

    Implementation of liquid cooling transforms a refrigeration system into a combined cooling and heating system. Reclaimed heat can be used for building heating purposes or can be sold. Carbon dioxide based refrigeration systems are considered to have a particularly high potential for becoming ecient...... heat energy producers. In this paper a CO2 system that operates in the subcritical region is examined. Modelling approach is presented, and used for operation optimisation by way of non-linear model predictive control techniques. Assuming that the heat is sold when using both objective functions......, it turns out that the system have negative operational cost. In case when Cost Minimization objective function is used daily revenue is about 7:9 [eur], for Prosumption one it is 11:9 [eur]....

  16. Un-bundling payments for radioisotopes from radiopharmaceuticals and from diagnostic procedures: A tool to support the implementation of full-cost recovery - NEA discussion document

    International Nuclear Information System (INIS)

    2012-09-01

    The objective of the NEA's HLG-MR policy approach is to ensure a long-term secure supply. The HLG-MR has determined that to attain that objective, a necessary (but not sufficient) requirement is that irradiation services in the 99 Mo/' 99m Tc supply chain must be provided on a full-cost recovery (FCR) basis (OECD-NEA, 2011). The HLG-MR policy approach also recommended that supply chain participants should implement payment reforms that promote full-cost recovery within their reimbursement systems. Reforms might include separate radioisotope pricing or auditing, separate radioisotope payment, differential radioisotope payment for FCR, or other approaches to promote a complete transition to full-cost recovery. This paper is written to provide a basis for further discussion on the use of separate reimbursement to encourage the move to full-cost recovery. Separate reimbursement is one tool that could be used by public and private health insurance to support the move to ensuring sufficient reimbursement rates (or payments) for 99 Mo/' 99m Tc while the industry moves to full-cost recovery for irradiation services, paying for outage reserve capacity and transitioning to using LEU targets. Other tools are available (such as differential payments, separate radioisotope payments, auditing) that could lead to similar outcomes that support the changes necessary in the 99 Mo/' 99m Tc supply chain to ensure a long-term reliable supply of these important medical isotopes

  17. The effect of sugammadex on postoperative cognitive function and recovery

    Directory of Open Access Journals (Sweden)

    Özcan Pişkin

    2016-07-01

    Full Text Available Background and objective: Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. Methods: Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S or the Neostigmine group (Group N. The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA and Mini Mental State Examination (MMSE. After baseline assessment 12–24 h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1 h later the MoCA tests were repeated. Results: Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p > 0.05. The time to reach TOF 0.9 was 2.19 min in Group S and 6.47 min in Group N (p  0,05. O tempo para atingir TOF 0.9 foi de 2,19 min no Grupo S e de 6,47 min no Grupo N (p < 0,0001. O tempo de recuperação foi de 8,26 min no Grupo S e de 16,93 min no Grupo N (p < 0,0001 Conclusão: Mostramos que o procedimento cirúrgico e/ou procedimento anestésico de acompanhamento pode causar uma regressão temporária ou permanente da função cognitiva no pós-operatório imediato. No entanto, um desempenho cognitivo melhor não pode ser provado no grupo sugamadex em comparação com o grupo neostigmina. Keywords: Sugammadex, Neostigmine, Postoperative cognitive dysfunction, MMSE, MoCA, Palavras-chave: Sugamadex, Neostigmina, Disfunção cognitiva no p

  18. Effects of Volcanic Eruptions on Stratospheric Ozone Recovery

    Science.gov (United States)

    Rosenfield, Joan E.

    2002-01-01

    The effects of the stratospheric sulfate aerosol layer associated with the Mt. Pinatubo volcano and future volcanic eruptions on the recovery of the ozone layer is studied with an interactive two-dimensional photochemical model. The time varying chlorine loading and the stratospheric cooling due to increasing carbon dioxide have been taken into account. The computed ozone and temperature changes associated with the Mt. Pinatubo eruption in 1991 agree well with observations. Long model runs out to the year 2050 have been carried out, in which volcanoes having the characteristics of the Mount Pinatubo volcano were erupted in the model at 10-year intervals starting in the year 2010. Compared to a non-volcanic run using background aerosol loading, transient reductions of globally averaged column ozone of 2-3 percent were computed as a result of each of these eruptions, with the ozone recovering to that computed for the non-volcanic case in about 5 years after the eruption. Computed springtime Arctic column ozone losses of from 10 to 18 percent also recovered to the non-volcanic case within 5 years. These results suggest that the long-term recovery of ozone would not be strongly affected by infrequent volcanic eruptions with a sulfur loading approximating Mt. Pinatubo. Sensitivity studies in which the Arctic lower stratosphere was forced to be 4 K and 10 K colder resulted in transient ozone losses of which also recovered to the non-volcanic case in 5 years. A case in which a volcano five times Mt. Pinatubo was erupted in the year 2010 led to maximum springtime column ozone losses of 45 percent which took 10 years to recover to the background case. Finally, in order to simulate a situation in which frequent smaller volcanic eruptions result in increasing the background sulfate loading, a simulation was made in which the background aerosol was increased by 10 percent per year. This resulted in a delay of the recovery of column ozone to 1980 values of more than 10 years.

  19. SOR 90-190, 22 March 1990, AECB Cost Recovery Fees Regulations

    International Nuclear Information System (INIS)

    1990-01-01

    These Regulations entered into force on 1 April 1990. They were made pursuant to the Atomic Energy Control Regulations and prescribe the legal obligations to pay fees imposed on applicants for and holders of licences from the Atomic Energy Control Board - AECB. The purpose of the Regulations is to shift the cost of government service from the general taxpayer to the users and to those who specifically benefit from the services. (NEA) [fr

  20. Cost recovery in geographic information systems and conflicts with copyright law

    Science.gov (United States)

    Roberts, Jon L.

    1993-10-01

    The ability to recover cost by the sale of geographic information is dependent upon the ownership of the copyright in and to that information. The ownership of the copyright turns upon whether one entity is an employee of the other or whether the copyrightable work falls within certain statutorily defined categories in the copyright law. Absent the specific requirements being fulfilled the ownership of the data may not be exactly as the parties expect.

  1. Cost (non)-recovery by platform technology facilities in the Bio21 Cluster.

    Science.gov (United States)

    Gibbs, Gerard; Clark, Stella; Quinn, Julieanne; Gleeson, Mary Joy

    2010-04-01

    Platform technologies (PT) are techniques or tools that enable a range of scientific investigations and are critical to today's advanced technology research environment. Once installed, they require specialized staff for their operations, who in turn, provide expertise to researchers in designing appropriate experiments. Through this pipeline, research outputs are raised to the benefit of the researcher and the host institution. Platform facilities provide access to instrumentation and expertise for a wide range of users beyond the host institution, including other academic and industry users. To maximize the return on these substantial public investments, this wider access needs to be supported. The question of support and the mechanisms through which this occurs need to be established based on a greater understanding of how PT facilities operate. This investigation was aimed at understanding if and how platform facilities across the Bio21 Cluster meet operating costs. Our investigation found: 74% of platforms surveyed do not recover 100% of direct operating costs and are heavily subsidized by their home institution, which has a vested interest in maintaining the technology platform; platform managers play a major role in establishing the costs and pricing of the facility, normally in a collaborative process with a management committee or institutional accountant; and most facilities have a three-tier pricing structure recognizing internal academic, external academic, and commercial clients.

  2. 10 CFR 436.13 - Presuming cost-effectiveness results.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Presuming cost-effectiveness results. 436.13 Section 436... Methodology and Procedures for Life Cycle Cost Analyses § 436.13 Presuming cost-effectiveness results. (a) If the investment and other costs for an energy or water conservation measure considered for retrofit to...

  3. Effects of chronic irradiation on spermatogenesis: recovery phase

    International Nuclear Information System (INIS)

    Day, P.A.; Shifrine, M.; Overstreet, J.W.

    1984-01-01

    Recovery of sperm production was not seen in four beagles rendered azoospermic or severely oligospermic by exposure to 183 R of gamma radiation given at a dose rate of 1 R/day. Two other dogs from the same group showed a partial recovery, but with very low sperm counts and many abnormal spermatozoa. 1 figure

  4. Cost-effective analysis of PET application in NSCLC

    International Nuclear Information System (INIS)

    Gu Aichun; Liu Jianjun; Sun Xiaoguang; Shi Yiping; Huang Gang

    2006-01-01

    Objective: To evaluate the cost-effectiveness of PET and CT application for diagnosis of non-small cell lung cancer (NSCLC) in China. Methods: Using decision analysis method the diagnostic efficiency of PET and CT for diagnosis of NSCLC in china was analysed. And also the value of cost for accurate diagnosis (CAD), cost for accurate staging (CAS) and cost for effective therapy (CAT) was calculated. Results: (1) For the accurate diagnosis, CT was much more cost-effective than PET. (2) For the accurate staging, CT was still more cost-effective than PET. (3) For the all over diagnostic and therapeutic cost, PET was more cost-effective than CT. (4) The priority of PET to CT was for the diagnosis of stage I NSCLC. Conclusion: For the management of NSCLC patient in China, CT is more cost-effective for screening, whereas PET for clinical staging and monitoring therapeutic effect. (authors)

  5. Costs of diarrheal disease and the cost-effectiveness of a rotavirus vaccination program in kyrgyzstan.

    Science.gov (United States)

    Flem, Elmira T; Latipov, Renat; Nurmatov, Zuridin S; Xue, Yiting; Kasymbekova, Kaliya T; Rheingans, Richard D

    2009-11-01

    We examined the cost-effectiveness of a rotavirus immunization program in Kyrgyzstan, a country eligible for vaccine funding from the GAVI Alliance. We estimated the burden of rotavirus disease and its economic consequences by using national and international data. A cost-effectiveness analysis was conducted from government and societal perspectives, along with a range of 1-way sensitivity analyses. Rotavirus-related hospitalizations and outpatient visits cost US$580,864 annually, of which $421,658 (73%) is direct medical costs and $159,206 (27%) is nonmedical and indirect costs. With 95% coverage, vaccination could prevent 75% of rotavirus-related hospitalizations and deaths and 56% of outpatient visits and could avert $386,193 (66%) in total costs annually. The medical break-even price at which averted direct medical costs equal vaccination costs is $0.65/dose; the societal break-even price is $1.14/dose for a 2-dose regimen. At the current GAVI Alliance-subsidized vaccine price of $0.60/course, rotavirus vaccination is cost-saving for the government. Vaccination is cost-effective at a vaccine price $9.41/dose, according to the cost-effectiveness standard set by the 2002 World Health Report. Addition of rotavirus vaccines to childhood immunization in Kyrgyzstan could substantially reduce disease burden and associated costs. Vaccination would be cost-effective from the national perspective at a vaccine price $9.41 per dose.

  6. [Effect of postoperative precision nutrition therapy on postoperative recovery for advanced gastric cancer after neoadjuvant chemotherapy].

    Science.gov (United States)

    Zhao, Q; Li, Y; Yu, B; Yang, P G; Fan, L Q; Tan, B B; Tian, Y; Yang, A B

    2018-02-23

    Objective: To investigate the effect of postoperative precision nutrition therapy on postoperative recovery (PR) of patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NC). Methods: 71 subjects were randomly divided into 2 groups. The 34 patients of research group were treated with postoperative precision nutrition treatment according to the indirect energy measurement method. The 31 patients of control group were treated with traditional postoperative nutrition treatment. All participants were measured for body mass index (BMI), NRS2002, PG-SGA and relevant laboratory test within the 1st day before surgery and 7th day after surgery. Moreover, the difference between two groups in short-term effects were evaluated. Results: The daily energy supply of control group was 30.1%-43.74% higher than that of the experimental group ( P nutritional risk became lower in the research group ( P recovery of patients in the research group was comparable to that of the control group ( P >0.05). Moreover, the complication rate and hospitalization costs of in research group were significantly lower than that of in control group ( P nutritional risks before surgery, the nutritional index and inflammatory index in the research group were better than those in the control group. Conclusion: Postoperative precision nutrition therapy may improve the postoperative nutritional status and short-term effects of patients with AGC after NC.

  7. Unbundling payments for radioisotopes from radiopharmaceuticals and from diagnostic procedures: A tool to support the implementation of full-cost recovery. NEA discussion document

    International Nuclear Information System (INIS)

    2012-01-01

    The objective of the NEA's HLG-MR policy approach is to ensure a long-term secure supply. The HLG-MR has determined that to attain that objective, a necessary (but not sufficient) requirement is that irradiation services in the 99 Mo/ 99m Tc supply chain must be provided on a full-cost recovery (FCR) basis (OECD-NEA, 2011). The HLG-MR policy approach also recommended that supply chain participants should implement payment reforms that promote full-cost recovery within their reimbursement systems. Reforms might include separate radioisotope pricing or auditing, separate radioisotope payment, differential radioisotope payment for FCR, or other approaches to promote a complete transition to full-cost recovery

  8. Health economic studies: an introduction to cost-benefit, cost-effectiveness, and cost-utility analyses.

    Science.gov (United States)

    Angevine, Peter D; Berven, Sigurd

    2014-10-15

    Narrative overview. To provide clinicians with a basic understanding of economic studies, including cost-benefit, cost-effectiveness, and cost-utility analyses. As decisions regarding public health policy, insurance reimbursement, and patient care incorporate factors other than traditional outcomes such as satisfaction or symptom resolution, health economic studies are increasingly prominent in the literature. This trend will likely continue, and it is therefore important for clinicians to have a fundamental understanding of the common types of economic studies and be able to read them critically. In this brief article, the basic concepts of economic studies and the differences between cost-benefit, cost-effectiveness, and cost-utility studies are discussed. An overview of the field of health economic analysis is presented. Cost-benefit, cost-effectiveness, and cost-utility studies all integrate cost and outcome data into a decision analysis model. These different types of studies are distinguished mainly by the way in which outcomes are valued. Obtaining accurate cost data is often difficult and can limit the generalizability of a study. With a basic understanding of health economic analysis, clinicians can be informed consumers of these important studies.

  9. An improved set of standards for finding cost for cost-effectiveness analysis.

    Science.gov (United States)

    Barnett, Paul G

    2009-07-01

    Guidelines have helped standardize methods of cost-effectiveness analysis, allowing different interventions to be compared and enhancing the generalizability of study findings. There is agreement that all relevant services be valued from the societal perspective using a long-term time horizon and that more exact methods be used to cost services most affected by the study intervention. Guidelines are not specific enough with respect to costing methods, however. The literature was reviewed to identify the problems associated with the 4 principal methods of cost determination. Microcosting requires direct measurement and is ordinarily reserved to cost novel interventions. Analysts should include nonwage labor cost, person-level and institutional overhead, and the cost of development, set-up activities, supplies, space, and screening. Activity-based cost systems have promise of finding accurate costs of all services provided, but are not widely adopted. Quality must be evaluated and the generalizability of cost estimates to other settings must be considered. Administrative cost estimates, chiefly cost-adjusted charges, are widely used, but the analyst must consider items excluded from the available system. Gross costing methods determine quantity of services used and employ a unit cost. If the intervention will affect the characteristics of a service, the method should not assume that the service is homogeneous. Questions are posed for future reviews of the quality of costing methods. The analyst must avoid inappropriate assumptions, especially those that bias the analysis by exclusion of costs that are affected by the intervention under study.

  10. The Effect of Different Recovery Duration on Repeated Anaerobic Performance in Elite Cyclists

    Directory of Open Access Journals (Sweden)

    Harbili Sultan

    2015-12-01

    Full Text Available This study investigated the effect of recovery duration on repeated anaerobic performance in elite cyclists. The study followed a cross-over design protocol. Twelve elite male cyclists were randomly assigned to three groups (with recovery duration of 1, 2 and 3 min, respectively. All the subjects performed 4 repeated Wingate tests (4 × 30 s WT at 48 h intervals for three different recovery periods. No significant interaction was observed between the effects of recovery duration and repetition (p>0.05, whereas there was a significant main effect of repetition on peak power, mean power, and a fatigue index (p0.05. In contrast, mean power decreased significantly in repeated WTs with 1, 2 and 3 min recovery duration (p0.05. In a 4 × 30 s WT, peak power decreased in cycles with 1 and 2 min recovery duration, but remained unchanged with 3 min recovery duration, whereas mean power decreased in all recovery duration procedures. The WT with 1 min recovery duration caused greater fatigue. Although recovery duration affected both peak power and mean power, the effect on peak power was greater.

  11. OPCAB surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Houlind, Kim Christian; Kjeldsen, Bo Juul; Madsen, Susanne Nørgaard

    2013-01-01

    To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....

  12. Understanding Cost-Effectiveness of Energy Efficiency Programs

    Science.gov (United States)

    Discusses the five standard tests used to assess the cost-effectiveness of energy efficiency, how states are using these tests, and how the tests can be used to determine the cost-effectiveness of energy efficiency measures.

  13. Recruiting phobic research subjects: effectiveness and cost.

    Science.gov (United States)

    Kaakko, T; Murtomaa, H; Milgrom, P; Getz, T; Ramsay, D S; Coldwell, S E

    2001-01-01

    Efficiently enrolling subjects is one of the most important and difficult aspects of a clinical trial. This prospective study evaluated strategies used in the recruitment of 144 dental injection phobics for a clinical trial evaluating the effectiveness of combining alprazolam with exposure therapy. Three types of recruitment strategies were evaluated: paid advertising, free publicity, and professional referral. Sixty-three percent of subjects were enrolled using paid advertising (the majority of them from bus advertisements [27.0%], posters on the University of Washington campus [20.1%], and newspaper advertisements [13.2%]). Free publicity (eg, television coverage, word of mouth) yielded 18.8% of enrolled subjects and professionaL referrals 14.6% of subjects. The average cost (1996 dollars) of enrolling 1 subject was $79. Bus and poster advertising attracted more initial contacts and yielded the greatest enrollment.

  14. Design And Implementation Of Cost Effective Inverter

    Directory of Open Access Journals (Sweden)

    Niaz Morshedul Haque

    2017-10-01

    Full Text Available This paper deals with the design and construct of a 100 Watt 220 Volt and 50 Hz Inverter. The system is designed without any microcontroller and it has a cost-effective design architecture. The elementary purpose of this device is to transmute 12 V DC to 220 V AC. Snubber technology is used to diminish the reverse potential transients and excessive heat of transformer winding and transistor switches. Switching pulse generated by NE 555 timer circuit and comparator circuit was used to take signal strength input from its rear as well as from both sides for triggering the MOSFET switches. Another switch is used to invert pulse between two switching circuitries. A 5 volts regulator IC 7805 was used to supply fixed 5V for biasing the switching and amplifying circuitry.

  15. Cost-effective implementation of intelligent systems

    Science.gov (United States)

    Lum, Henry, Jr.; Heer, Ewald

    1990-01-01

    Significant advances have occurred during the last decade in knowledge-based engineering research and knowledge-based system (KBS) demonstrations and evaluations using integrated intelligent system technologies. Performance and simulation data obtained to date in real-time operational environments suggest that cost-effective utilization of intelligent system technologies can be realized. In this paper the rationale and potential benefits for typical examples of application projects that demonstrate an increase in productivity through the use of intelligent system technologies are discussed. These demonstration projects have provided an insight into additional technology needs and cultural barriers which are currently impeding the transition of the technology into operational environments. Proposed methods which addresses technology evolution and implementation are also discussed.

  16. Diet-dependent heat emission reveals costs of post-diapause recovery from different nutritional sources in a carnivorous beetle

    Science.gov (United States)

    Toft, Søren; Nielsen, Søren Achim

    2017-08-01

    Restoration of fat stores is metabolic first priority for many insects that emerge from hibernation with depleted fat bodies. To some extent, the animals must be flexible and use whatever foods available irrespective of their nutrient composition. Previously, the carabid beetles Anchomenus dorsalis have been found to refill their fat stores to the same extent over 9 days irrespective of the nutrient composition of their food. However, a higher cost of fat deposition when the food was rich in sugar or protein rather than lipid was indicated by higher total energy consumption. Here, we test the hypothesis of increased metabolic costs of building fat stores from sugar- or protein-rich food than from lipid-rich food by microcalorimetry. We measured the heat emitted from beetles that had fed on sugar-, protein-, or lipid-rich food for 0 (common control), 2, 5, or 10 days. As predicted, heat emission was increased in beetles getting sugar- and protein-rich food compared with those getting lipid-rich food. However, we did not confirm the beetles' ability to rebuild fat stores from protein-rich food; instead, they increased in lean mass. Overall, sugar-rich food seems to be optimal for post-winter recovery, because it is better than lipid-rich food that allows concurrent rebuilding of fat stores and lean mass, which may benefit preparation for spring migration and reproduction. We propose that overwintered fruits may be highly preferred post-diapause food for these otherwise mostly carnivorous beetles.

  17. 10 CFR 455.63 - Cost-effectiveness testing.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.63 Cost-effectiveness testing. (a... paragraph (a) of this section, if the State plan requires the cost effectiveness of an energy conservation...

  18. Cost Effectiveness of Premium Versus Regular Gasoline in MCPS Buses.

    Science.gov (United States)

    Baacke, Clifford M.; Frankel, Steven M.

    The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…

  19. Controlling Campylobacter in the chicken meat chain - Cost-effectiveness and cost-utility analysis

    NARCIS (Netherlands)

    Mangen MJJ; Havelaar AH; Nauta MJ; Koeijer AA de; Wit GA de; LEI; Animal Sciences Group; PZO; MGB

    2005-01-01

    The aim of this study was the estimation of cost-effectiveness and cost-utility of various interventions to control Campylobacter contamination of broiler meat. The relative risk, the intervention costs, the disease burden (expressed in Disability Adjusted Live Years (DALYs)) and the

  20. Financial and accounting alternatives for the recovery of nuclear plant decommissioning costs

    International Nuclear Information System (INIS)

    Collins, P.A.

    1980-01-01

    Compared are 12 different methods of financing the decommissioning of nuclear power plants. The basic financing alternatives are presented first in their simple version where income taxes are zero. Then the effects of the present income tax laws are added and their effect determined

  1. Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya

    Directory of Open Access Journals (Sweden)

    Jukes Matthew CH

    2008-09-01

    Full Text Available Abstract Background Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT as delivered by teachers in schools in western Kenya. Methods Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly. Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness. Results The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year. The estimated cost per anaemia case averted was US$ 29.84 and the cost per case of Plasmodium falciparum parasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively. Conclusion This

  2. Low Cost Advanced Thermoelectric (TE) Technology for Automotive Waste Heat Recovery

    Science.gov (United States)

    Meisner, G. P.

    2014-03-01

    Low cost, fully integrated TE generators (TEGs) to recover waste heat from vehicle exhaust will reduce transportation sector energy consumption and emissions. TEGs will be the first application of high-temperature TE materials for high-volume use and establish new industrial sectors with scaled up production capability of TEG materials and components. We will create a potential supply chain for practical automotive TEGs and identify manufacturing and assembly processes for large scale production of TEG materials and components. Our work focusses on several innovative R&D paths: (1) enhanced TE material performance by doping and compositional tuning, (2) optimized TE material fabrication and processing to reduce thermal conductivity and improve fracture strength, (3) high volume production for successful skutterudite commercialization, (4) new material, nanostructure, and nanoscale approaches to reduce thermal interface and electrical contact resistances, (5) innovative heat exchangers for high efficiency heat flows and optimum temperature profiles despite highly variable exhaust gas operating conditions, (6) new modeling and simulation tools, and (7) inexpensive materials for thermal insulation and coatings for TE encapsulation. Recent results will be presented. Supported by the U.S. DOE Vehicle Technology Program.

  3. Process control, energy recovery and cost savings in acetic acid wastewater treatment

    International Nuclear Information System (INIS)

    Vaiopoulou, E.; Melidis, P.; Aivasidis, A.

    2011-01-01

    An anaerobic fixed bed loop (AFBL) reactor was applied for treatment of acetic acid (HAc) wastewater. Two pH process control concepts were investigated; auxostatic and chemostatic control. In the auxostatic pH control, feed pump is interrupted when pH falls below a certain pH value in the bioreactor, which results in reactor operation at maximum load. Chemostatic control assures alkaline conditions by setting a certain pH value in the influent, preventing initial reactor acidification. The AFBL reactor treated HAc wastewater at low hydraulic residence time (HRT) (10-12 h), performed at high space time loads (40-45 kg COD/m 3 d) and high space time yield (30-35 kg COD/m 3 d) to achieve high COD (Chemical Oxygen Demand) removal (80%). Material and cost savings were accomplished by utilizing the microbial potential for wastewater neutralization during anaerobic treatment along with application of favourable pH-auxostatic control. NaOH requirement for neutralization was reduced by 75% and HRT was increased up to 20 h. Energy was recovered by applying costless CO 2 contained in the biogas for neutralization of alkaline wastewater. Biogas was enriched in methane by 4 times. This actually brings in more energy profits, since biogas extra heating for CO 2 content during biogas combustion is minimized and usage of other acidifying agents is omitted.

  4. FORECAST: Regulatory effects cost analysis software annual

    International Nuclear Information System (INIS)

    Lopez, B.; Sciacca, F.W.

    1991-11-01

    Over the past several years the NRC has developed a generic cost methodology for the quantification of cost/economic impacts associated with a wide range of new or revised regulatory requirements. This methodology has been developed to aid the NRC in preparing Regulatory Impact Analyses (RIAs). These generic costing methods can be useful in quantifying impacts both to industry and to the NRC. The FORECAST program was developed to facilitate the use of the generic costing methodology. This PC program integrates the major cost considerations that may be required because of a regulatory change. FORECAST automates much of the calculations typically needed in an RIA and thus reduces the time and labor required to perform these analysis. More importantly, its integrated and consistent treatment of the different cost elements should help assure comprehensiveness, uniformity, and accuracy in the preparation of needed cost estimates

  5. Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India.

    OpenAIRE

    Floyd, Katherine; Arora, V. K.; Murthy, K. J. R.; Lonnroth, Knut; Singla, Neeta; Akbar, Y.; Zignol, Matteo; Uplekar, Mukund

    2006-01-01

    OBJECTIVE: To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. METHODS: We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the publ...

  6. Greenhouse Gas Concentration Data Recovery Algorithm for a Low Cost, Laser Heterodyne Radiometer

    Science.gov (United States)

    Miller, J. Houston; Melroy, Hilary R.; Ott, Lesley E.; Mclinden, Matthew L.; Holben, Brent; Wilson, Emily L.

    2012-01-01

    The goal of a coordinated effort between groups at GWU and NASA GSFC is the development of a low-cost, global, surface instrument network that continuously monitors three key carbon cycle gases in the atmospheric column: carbon dioxide (CO2), methane (CH4), carbon monoxide (CO), as well as oxygen (O2) for atmospheric pressure profiles. The network will implement a low-cost, miniaturized, laser heterodyne radiometer (mini-LHR) that has recently been developed at NASA Goddard Space Flight Center. This mini-LHR is designed to operate in tandem with the passive aerosol sensor currently used in AERONET (a well established network of more than 450 ground aerosol monitoring instruments worldwide), and could be rapidly deployed into this established global network. Laser heterodyne radiometry is a well-established technique for detecting weak signals that was adapted from radio receiver technology. Here, a weak light signal, that has undergone absorption by atmospheric components, is mixed with light from a distributed feedback (DFB) telecommunications laser on a single-mode optical fiber. The RF component of the signal is detected on a fast photoreceiver. Scanning the laser through an absorption feature in the infrared, results in a scanned heterodyne signal io the RF. Deconvolution of this signal through the retrieval algorithm allows for the extraction of altitude contributions to the column signal. The retrieval algorithm is based on a spectral simulation program, SpecSyn, developed at GWU for high-resolution infrared spectroscopies. Variations io pressure, temperature, composition, and refractive index through the atmosphere; that are all functions of latitude, longitude, time of day, altitude, etc.; are modeled using algorithms developed in the MODTRAN program developed in part by the US Air Force Research Laboratory. In these calculations the atmosphere is modeled as a series of spherically symmetric shells with boundaries specified at defined altitudes. Temperature

  7. Greenhouse Gas Concentration Data Recovery Algorithm for a Low Cost, Laser Heterodyne Radiometer

    Science.gov (United States)

    Miller, J. H.; Melroy, H.; Ott, L.; McLinden, M. L.; Holben, B. N.; Wilson, E. L.

    2012-12-01

    The goal of a coordinated effort between groups at GWU and NASA GSFC is the development of a low-cost, global, surface instrument network that continuously monitors three key carbon cycle gases in the atmospheric column: carbon dioxide (CO2), methane (CH4), carbon monoxide (CO), as well as oxygen (O2) for atmospheric pressure profiles. The network will implement a low-cost, miniaturized, laser heterodyne radiometer (mini-LHR) that has recently been developed at NASA Goddard Space Flight Center. This mini-LHR is designed to operate in tandem with the passive aerosol sensor currently used in AERONET (a well established network of more than 450 ground aerosol monitoring instruments worldwide), and could be rapidly deployed into this established global network. Laser heterodyne radiometry is a well-established technique for detecting weak signals that was adapted from radio receiver technology. Here, a weak light signal, that has undergone absorption by atmospheric components, is mixed with light from a distributed feedback (DFB) telecommunications laser on a single-mode optical fiber. The RF component of the signal is detected on a fast photoreceiver. Scanning the laser through an absorption feature in the infrared, results in a scanned heterodyne signal in the RF. Deconvolution of this signal through the retrieval algorithm allows for the extraction of altitude contributions to the column signal. The retrieval algorithm is based on a spectral simulation program, SpecSyn, developed at GWU for high-resolution infrared spectroscopies. Variations in pressure, temperature, composition, and refractive index through the atmosphere; that are all functions of latitude, longitude, time of day, altitude, etc.; are modeled using algorithms developed in the MODTRAN program developed in part by the US Air Force Research Laboratory. In these calculations the atmosphere is modeled as a series of spherically symmetric shells with boundaries specified at defined altitudes. Temperature

  8. Final Technical Report - Recovery Act: Organic Coatings as Encapsulants for Low Cost, High Performance PV Modules

    Energy Technology Data Exchange (ETDEWEB)

    Stuart Hellring; Jiping Shao; James Poole

    2011-12-05

    The objective of this project was to evaluate the feasibility of utilizing PPG's commercial organic coatings systems as efficient, modernized encapsulants for low cost, high performance, thin film photovoltaic modules. Our hypothesis was that the combination of an anticorrosive coating with a more traditional barrier topcoat would mitigate many electrochemical processes that are now responsible for the significant portion of photovoltaic (PV) failures, thereby nullifying the extremely high moisture barrier requirements of currently used encapsulation technology. Nine commercially available metal primer coatings and six commercially available top coatings were selected for screening. Twenty-one different primer/top coat combinations were evaluated. The primer coatings were shown to be the major contributor to corrosion inhibition, adhesion, and barrier properties. Two primer coatings and one top coating were downselected for testing on specially-fabricated test modules. The coated test modules passed initial current leakage and insulation testing. Damp Heat testing of control modules showed visible corrosion to the bus bar metal, whereas the coated modules showed none. One of the primer/top coat combinations retained solar power performance after Damp Heat testing despite showing some delamination at the EVA/solar cell interface. Thermal Cycling and Humidity Freeze testing resulted in only one test module retaining its power performance. Failure modes depended on the particular primer/top coating combination used. Overall, this study demonstrated that a relatively thin primer/top coating has the potential to replace the potting film and backsheet in crystalline silicon-based photovoltaic modules. Positive signals were received from commercially available coatings developed for applications having performance requirements different from those required for photovoltaic modules. It is likely that future work to redesign and customize these coatings would result in

  9. The Effects of Total Sleep Deprivation and Recovery Sleep on Cognitive Performance and Brain Function

    National Research Council Canada - National Science Library

    Drummond, Sean P

    2004-01-01

    .... Even less is known about the cerebral effects of recovery sleep. The overarching objective of this study is to investigate the effects of 2 full nights of sleep loss and 2 full nights of recovery sleep on cognitive performance and brain function...

  10. The Effects of Total Sleep Deprivation and Recovery Sleep on Cognitive Performance and Brain Function

    National Research Council Canada - National Science Library

    Gillin, J

    2003-01-01

    ..... Even less is known about the cerebral effects of recovery sleep. The objective of this study is to investigate the effects of 2 full nights of sleep loss and 2 full nights of recovery sleep on cognitive performance and brain function...

  11. Reading Recovery: Exploring the Effects on First-Graders' Reading Motivation and Achievement

    Science.gov (United States)

    Bates, Celeste C.; D'Agostino, Jerome V.; Gambrell, Linda; Xu, Meling

    2016-01-01

    This study examined the effects of Reading Recovery on children's motivational levels, and how motivation may contribute to the effect of the intervention on literacy achievement. Prior studies concluded that Reading Recovery was positively associated with increased student motivation levels, but most of those studies were limited…

  12. Consumer-Operated Service Programs: monetary and donated costs and cost-effectiveness.

    Science.gov (United States)

    Yates, Brian T; Mannix, Danyelle; Freed, Michael C; Campbell, Jean; Johnsen, Matthew; Jones, Kristine; Blyler, Crystal R

    2011-01-01

    Examine cost differences between Consumer Operated Service Programs (COSPs) as possibly determined by a) size of program, b) use of volunteers and other donated resources, c) cost-of-living differences between program locales, d) COSP model applied, and e) delivery system used to implement the COSP model. As part of a larger evaluation of COSP, data on operating costs, enrollments, and mobilization of donated resources were collected for eight programs representing three COSP models (drop-in centers, mutual support, and education/advocacy training). Because the 8 programs were operated in geographically diverse areas of the US, costs were examined with and without adjustment for differences in local cost of living. Because some COSPs use volunteers and other donated resources, costs were measured with and without these resources being monetized. Scale of operation also was considered as a mediating variable for differences in program costs. Cost per visit, cost per consumer per quarter, and total program cost were calculated separately for funds spent and for resources donated for each COSP. Differences between COSPs in cost per consumer and cost per visit seem better explained by economies of scale and delivery system used than by cost-of-living differences between program locations or COSP model. Given others' findings that different COSP models produce little variation in service effectiveness, minimize service costs by maximizing scale of operation while using a delivery system that allows staff and facilities resources to be increased or decreased quickly to match number of consumers seeking services.

  13. Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive-behavioural therapy in out-patients with anorexia nervosa.

    Science.gov (United States)

    Egger, N; Wild, B; Zipfel, S; Junne, F; Konnopka, A; Schmidt, U; de Zwaan, M; Herpertz, S; Zeeck, A; Löwe, B; von Wietersheim, J; Tagay, S; Burgmer, M; Dinkel, A; Herzog, W; König, H-H

    2016-12-01

    Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive-behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN. The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost-utility and assumptions underlying the base case were investigated in exploratory analyses. Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends. Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.

  14. Comparative costs and cost-effectiveness of behavioural interventions as part of HIV prevention strategies.

    Science.gov (United States)

    Hsu, Justine; Zinsou, Cyprien; Parkhurst, Justin; N'Dour, Marguerite; Foyet, Léger; Mueller, Dirk H

    2013-01-01

    Behavioural interventions have been widely integrated in HIV/AIDS social marketing prevention strategies and are considered valuable in settings with high levels of risk behaviours and low levels of HIV/AIDS awareness. Despite their widespread application, there is a lack of economic evaluations comparing different behaviour change communication methods. This paper analyses the costs to increase awareness and the cost-effectiveness to influence behaviour change for five interventions in Benin. Cost and cost-effectiveness analyses used economic costs and primary effectiveness data drawn from surveys. Costs were collected for provider inputs required to implement the interventions in 2009 and analysed by 'person reached'. Cost-effectiveness was analysed by 'person reporting systematic condom use'. Sensitivity analyses were performed on all uncertain variables and major assumptions. Cost-per-person reached varies by method, with public outreach events the least costly (US$2.29) and billboards the most costly (US$25.07). Influence on reported behaviour was limited: only three of the five interventions were found to have a significant statistical correlation with reported condom use (i.e. magazines, radio broadcasts, public outreach events). Cost-effectiveness ratios per person reporting systematic condom use resulted in the following ranking: magazines, radio and public outreach events. Sensitivity analyses indicate rankings are insensitive to variation of key parameters although ratios must be interpreted with caution. This analysis suggests that while individual interventions are an attractive use of resources to raise awareness, this may not translate into a cost-effective impact on behaviour change. The study found that the extensive reach of public outreach events did not seem to influence behaviour change as cost-effectively when compared with magazines or radio broadcasts. Behavioural interventions are context-specific and their effectiveness influenced by a

  15. [Cost effectiveness of workplace smoking policies].

    Science.gov (United States)

    Raaijmakers, Tamara; van den Borne, Inge

    2003-01-01

    This study reviews the motivations of companies to set out a policy for controlling smoking, the economic benefits for the company resulting from such a policy and the costs, broken down by European Union countries. The literature on the costs of implementing a policy related to smoking at the workplace is reviewed. The main objective of policies related to smoking at the workplace is that of safeguarding employees from environmental tobacco smoke. Other reasons are cutting costs, improving the company image, and reducing absenteeism, occupational accidents, internal quarrels and extra costs due to cigarette smoking, protection against environmental tobacco smoke does not entail any higher costs for companies, and economic advantages are visible. The benefits are by far greater than the costs involved, particularly on a long-range basis, and seem to be greater when smoking at the workplace is completely prohibited and no smoking areas are set.

  16. The Effects of Electrostimulation and Core Exercises on Recovery After High-Intensity Exercise

    OpenAIRE

    Ahmet Mor; Gökhan İpekoğlu; Cansel Arslanoglu; Kursat Acar; Erkal Arslanoglu

    2017-01-01

    Introduction and objectives: The purpose of this study was to determine the effects of electrostimulation and core exercises on recovery after high-intensity exercise. Methods: The participants of this study consists of 12 male bodybuilders who regularly train and between the ages 18-30. Tabata high intensity interval training (HIIT) was applied with different recovery methods to the athletes on three different days and the recovery levels of athletes were analysed. Heart rate and blood lacta...

  17. Simulation Opportunity Index, A Simple and Effective Method to Boost the Hydrocarbon Recovery

    KAUST Repository

    Saputra, Wardana

    2016-09-08

    During periods of low oil prices, profitability of field developments drops drastically. To help with this difficulty, a cost-effective method has been proposed to boost the hydrocarbon recovery by optimizing well locations through the Simulated Opportunity Index (SOI). SOI is an intelligent method to identify zones with high potential for production which is empirically calculated from basic rock and fluid properties, and from reservoir pressure as its energy capacity. In order to obtain the best results, the original SOI formula (Molina et al., 2009) was extended to both oil and gas fields. Based on this modified SOI formula, a software program has been developed to locate the best well locations considering multilayer, existing wells, and fault existences. This paper describes how the SOI software helps as a simple, fast, and accurate way to obtain the higher hydrocarbon production than that of trial-error method and previous studies in two different fields located in offshore Indonesia. On one hand, the proposed method could save money by minimizing the required number of wells. On the other hand, it could maximize profit by maximizing recovery.

  18. Future Costs, Fixed Healthcare Budgets, and the Decision Rules of Cost-Effectiveness Analysis.

    Science.gov (United States)

    van Baal, Pieter; Meltzer, David; Brouwer, Werner

    2016-02-01

    Life-saving medical technologies result in additional demand for health care due to increased life expectancy. However, most economic evaluations do not include all medical costs that may result from this additional demand in health care and include only future costs of related illnesses. Although there has been much debate regarding the question to which extent future costs should be included from a societal perspective, the appropriate role of future medical costs in the widely adopted but more narrow healthcare perspective has been neglected. Using a theoretical model, we demonstrate that optimal decision rules for cost-effectiveness analyses assuming fixed healthcare budgets dictate that future costs of both related and unrelated medical care should be included. Practical relevance of including the costs of future unrelated medical care is illustrated using the example of transcatheter aortic valve implantation. Our findings suggest that guidelines should prescribe inclusion of these costs. Copyright © 2014 John Wiley & Sons, Ltd.

  19. The cost of preventing undernutrition: cost, cost-efficiency and cost-effectiveness of three cash-based interventions on nutrition outcomes in Dadu, Pakistan.

    Science.gov (United States)

    Trenouth, Lani; Colbourn, Timothy; Fenn, Bridget; Pietzsch, Silke; Myatt, Mark; Puett, Chloe

    2018-07-01

    Cash-based interventions (CBIs) increasingly are being used to deliver humanitarian assistance and there is growing interest in the cost-effectiveness of cash transfers for preventing undernutrition in emergency contexts. The objectives of this study were to assess the costs, cost-efficiency and cost-effectiveness in achieving nutrition outcomes of three CBIs in southern Pakistan: a 'double cash' (DC) transfer, a 'standard cash' (SC) transfer and a 'fresh food voucher' (FFV) transfer. Cash and FFVs were provided to poor households with children aged 6-48 months for 6 months in 2015. The SC and FFV interventions provided $14 monthly and the DC provided $28 monthly. Cost data were collected via institutional accounting records, interviews, programme observation, document review and household survey. Cost-effectiveness was assessed as cost per case of wasting, stunting and disability-adjusted life year (DALY) averted. Beneficiary costs were higher for the cash groups than the voucher group. Net total cost transfer ratios (TCTRs) were estimated as 1.82 for DC, 2.82 for SC and 2.73 for FFV. Yet, despite the higher operational costs, the FFV TCTR was lower than the SC TCTR when incorporating the participation cost to households, demonstrating the relevance of including beneficiary costs in cost-efficiency estimations. The DC intervention achieved a reduction in wasting, at $4865 per case averted; neither the SC nor the FFV interventions reduced wasting. The cost per case of stunting averted was $1290 for DC, $882 for SC and $883 for FFV. The cost per DALY averted was $641 for DC, $434 for SC and $563 for FFV without discounting or age weighting. These interventions are highly cost-effective by international thresholds. While it is debatable whether these resource requirements represent a feasible or sustainable investment given low health expenditures in Pakistan, these findings may provide justification for continuing Pakistan's investment in national social safety

  20. Ethical objections against including life-extension costs in cost-effectiveness analysis: a consistent approach.

    Science.gov (United States)

    Gandjour, Afschin; Müller, Dirk

    2014-10-01

    One of the major ethical concerns regarding cost-effectiveness analysis in health care has been the inclusion of life-extension costs ("it is cheaper to let people die"). For this reason, many analysts have opted to rule out life-extension costs from the analysis. However, surprisingly little has been written in the health economics literature regarding this ethical concern and the resulting practice. The purpose of this work was to present a framework and potential solution for ethical objections against life-extension costs. This work found three levels of ethical concern: (i) with respect to all life-extension costs (disease-related and -unrelated); (ii) with respect to disease-unrelated costs only; and (iii) regarding disease-unrelated costs plus disease-related costs not influenced by the intervention. Excluding all life-extension costs for ethical reasons would require-for reasons of consistency-a simultaneous exclusion of savings from reducing morbidity. At the other extreme, excluding only disease-unrelated life-extension costs for ethical reasons would require-again for reasons of consistency-the exclusion of health gains due to treatment of unrelated diseases. Therefore, addressing ethical concerns regarding the inclusion of life-extension costs necessitates fundamental changes in the calculation of cost effectiveness.

  1. Cost effectiveness of Tuberculosis Treatment from the Patients ...

    African Journals Online (AJOL)

    ... Directly Observed Treatment Short course is more cost effective from the patients' point of view. DOTS needs to be re-focused out of the hospitals and clinics and made community based in view of the increasing TB caseload occasioned by HI V/AIDS. Key Words: Cost effectiveness, Tuberculosis treatment, personal cost, ...

  2. Development of More Effective Biosurfactants for Enhanced Oil Recovery

    Energy Technology Data Exchange (ETDEWEB)

    McInerney, J.J.; Han, S.O.; Maudgalya, S.; Mouttaki, H.; Folmsbee, M.; Knapp, R.; Nagle, D.; Jackson, B.E.; Stuadt, M.; Frey, W.

    2003-01-16

    The objectives of this were two fold. First, core displacement studies were done to determine whether microbial processes could recover residual oil at elevated pressures. Second, the importance of biosurfactant production for the recovery of residual oil was studies. In these studies, a biosurfactant-producing, microorganisms called Bacillus licheniformis strain JF-2 was used. This bacterium produces a cyclic peptide biosurfactant that significantly reduces the interfacial tension between oil and brine (7). The use of a mutant deficient in surfactant production and a mathematical MEOR simulator were used to determine the major mechanisms of oil recovery by these two strains.

  3. Microbial Enhanced Oil Recovery: 3D Simulation with Gravity Effects

    DEFF Research Database (Denmark)

    Nielsen, Sidsel Marie; Jessen, K.; Shapiro, Alexander

    2010-01-01

    Microbial enhanced oil recovery (MEOR) utilizes the activity of microorganisms, where microorganisms simultaneously grow in a reservoir and convert substrate into recovery enhancing products (usually, surfactants). In order to predict the performance of a MEOR process, a simulation tool is required...... using an operator splitting technique. To the best of our knowledge, this has resulted in the first full 3D MEOR streamline simulator. For verification purposes, we compare results from our streamline MEOR simulator to those of a conventional finite difference approach for 1D and 2D displacement...

  4. Sunk costs equal sunk boats? The effect of entry costs in a transboundary sequential fishery

    DEFF Research Database (Denmark)

    Punt, M. J.

    2017-01-01

    that for other fisheries substantial sunk investments are needed. In this paper I investigate the effect of such sunk entry costs in a sequential fisheries. I model the uncertainty as a shock to the stock dependent fishing costs, in a two player game, where one of the players faces sunk entry costs. I find that......, depending on parameters, sunk costs can i) increase the competitive pressure on the fish stock compared to a game where entry is free ii) act as a deterrence mechanism and iii) act as a commitment device. I conclude that entry costs can play a crucial role because they can change the outcome of the game...

  5. Bayesian models for cost-effectiveness analysis in the presence of structural zero costs.

    Science.gov (United States)

    Baio, Gianluca

    2014-05-20

    Bayesian modelling for cost-effectiveness data has received much attention in both the health economics and the statistical literature, in recent years. Cost-effectiveness data are characterised by a relatively complex structure of relationships linking a suitable measure of clinical benefit (e.g. quality-adjusted life years) and the associated costs. Simplifying assumptions, such as (bivariate) normality of the underlying distributions, are usually not granted, particularly for the cost variable, which is characterised by markedly skewed distributions. In addition, individual-level data sets are often characterised by the presence of structural zeros in the cost variable. Hurdle models can be used to account for the presence of excess zeros in a distribution and have been applied in the context of cost data. We extend their application to cost-effectiveness data, defining a full Bayesian specification, which consists of a model for the individual probability of null costs, a marginal model for the costs and a conditional model for the measure of effectiveness (given the observed costs). We presented the model using a working example to describe its main features. © 2013 The Authors. Statistics in Medicine published by John Wiley & Sons, Ltd.

  6. The costs and cost-effectiveness of an integrated sepsis treatment protocol.

    Science.gov (United States)

    Talmor, Daniel; Greenberg, Dan; Howell, Michael D; Lisbon, Alan; Novack, Victor; Shapiro, Nathan

    2008-04-01

    Sepsis is associated with high mortality and treatment costs. International guidelines recommend the implementation of integrated sepsis protocols; however, the true cost and cost-effectiveness of these are unknown. To assess the cost-effectiveness of an integrated sepsis protocol, as compared with conventional care. Prospective cohort study of consecutive patients presenting with septic shock and enrolled in the institution's integrated sepsis protocol. Clinical and economic outcomes were compared with a historical control cohort. Beth Israel Deaconess Medical Center. Overall, 79 patients presenting to the emergency department with septic shock in the treatment cohort and 51 patients in the control group. An integrated sepsis treatment protocol incorporating empirical antibiotics, early goal-directed therapy, intensive insulin therapy, lung-protective ventilation, and consideration for drotrecogin alfa and steroid therapy. In-hospital treatment costs were collected using the hospital's detailed accounting system. The cost-effectiveness analysis was performed from the perspective of the healthcare system using a lifetime horizon. The primary end point for the cost-effectiveness analysis was the incremental cost per quality-adjusted life year gained. Mortality in the treatment group was 20.3% vs. 29.4% in the control group (p = .23). Implementing an integrated sepsis protocol resulted in a mean increase in cost of approximately $8,800 per patient, largely driven by increased intensive care unit length of stay. Life expectancy and quality-adjusted life years were higher in the treatment group; 0.78 and 0.54, respectively. The protocol was associated with an incremental cost of $11,274 per life-year saved and a cost of $16,309 per quality-adjusted life year gained. In patients with septic shock, an integrated sepsis protocol, although not cost-saving, appears to be cost-effective and compares very favorably to other commonly delivered acute care interventions.

  7. Cost effective waste management through composting in Africa

    Energy Technology Data Exchange (ETDEWEB)

    Couth, R. [CRECHE, Centre for Environmental, Coastal and Hydrological Engineering, Civil Engineering Programme, School of Engineering, University of KwaZulu-Natal, Durban 4041 (South Africa); Trois, C., E-mail: troisc@ukzn.ac.za [CRECHE, Centre for Environmental, Coastal and Hydrological Engineering, Civil Engineering Programme, School of Engineering, University of KwaZulu-Natal, Durban 4041 (South Africa)

    2012-12-15

    Highlights: Black-Right-Pointing-Pointer The financial/social/institutional sustainability of waste management in Africa is analysed. Black-Right-Pointing-Pointer This note is a compendium of a study on the potential for GHG control via improved zero waste in Africa. Black-Right-Pointing-Pointer This study provides the framework for Local Authorities for realizing sustained GHG reductions. - Abstract: Greenhouse gas (GHG) emissions per person from urban waste management activities are greater in sub-Saharan African countries than in other developing countries, and are increasing as the population becomes more urbanised. Waste from urban areas across Africa is essentially dumped on the ground and there is little control over the resulting gas emissions. The clean development mechanism (CDM), from the 1997 Kyoto Protocol has been the vehicle to initiate projects to control GHG emissions in Africa. However, very few of these projects have been implemented and properly registered. A much more efficient and cost effective way to control GHG emissions from waste is to stabilise the waste via composting and to use the composted material as a soil improver/organic fertiliser or as a component of growing media. Compost can be produced by open windrow or in-vessel composting plants. This paper shows that passively aerated open windrows constitute an appropriate low-cost option for African countries. However, to provide an usable compost material it is recommended that waste is processed through a materials recovery facility (MRF) before being composted. The paper demonstrates that material and biological treatment (MBT) are viable in Africa where they are funded, e.g. CDM. However, they are unlikely to be instigated unless there is a replacement to the Kyoto Protocol, which ceases for Registration in December 2012.

  8. Cost effective waste management through composting in Africa

    International Nuclear Information System (INIS)

    Couth, R.; Trois, C.

    2012-01-01

    Highlights: ► The financial/social/institutional sustainability of waste management in Africa is analysed. ► This note is a compendium of a study on the potential for GHG control via improved zero waste in Africa. ► This study provides the framework for Local Authorities for realizing sustained GHG reductions. - Abstract: Greenhouse gas (GHG) emissions per person from urban waste management activities are greater in sub-Saharan African countries than in other developing countries, and are increasing as the population becomes more urbanised. Waste from urban areas across Africa is essentially dumped on the ground and there is little control over the resulting gas emissions. The clean development mechanism (CDM), from the 1997 Kyoto Protocol has been the vehicle to initiate projects to control GHG emissions in Africa. However, very few of these projects have been implemented and properly registered. A much more efficient and cost effective way to control GHG emissions from waste is to stabilise the waste via composting and to use the composted material as a soil improver/organic fertiliser or as a component of growing media. Compost can be produced by open windrow or in-vessel composting plants. This paper shows that passively aerated open windrows constitute an appropriate low-cost option for African countries. However, to provide an usable compost material it is recommended that waste is processed through a materials recovery facility (MRF) before being composted. The paper demonstrates that material and biological treatment (MBT) are viable in Africa where they are funded, e.g. CDM. However, they are unlikely to be instigated unless there is a replacement to the Kyoto Protocol, which ceases for Registration in December 2012.

  9. Costs and cost-effectiveness of malaria control interventions - a systematic review

    Directory of Open Access Journals (Sweden)

    White Michael T

    2011-11-01

    Full Text Available Abstract Background The control and elimination of malaria requires expanded coverage of and access to effective malaria control interventions such as insecticide-treated nets (ITNs, indoor residual spraying (IRS, intermittent preventive treatment (IPT, diagnostic testing and appropriate treatment. Decisions on how to scale up the coverage of these interventions need to be based on evidence of programme effectiveness, equity and cost-effectiveness. Methods A systematic review of the published literature on the costs and cost-effectiveness of malaria interventions was undertaken. All costs and cost-effectiveness ratios were inflated to 2009 USD to allow comparison of the costs and benefits of several different interventions through various delivery channels, across different geographical regions and from varying costing perspectives. Results Fifty-five studies of the costs and forty three studies of the cost-effectiveness of malaria interventions were identified, 78% of which were undertaken in sub-Saharan Africa, 18% in Asia and 4% in South America. The median financial cost of protecting one person for one year was $2.20 (range $0.88-$9.54 for ITNs, $6.70 (range $2.22-$12.85 for IRS, $0.60 (range $0.48-$1.08 for IPT in infants, $4.03 (range $1.25-$11.80 for IPT in children, and $2.06 (range $0.47-$3.36 for IPT in pregnant women. The median financial cost of diagnosing a case of malaria was $4.32 (range $0.34-$9.34. The median financial cost of treating an episode of uncomplicated malaria was $5.84 (range $2.36-$23.65 and the median financial cost of treating an episode of severe malaria was $30.26 (range $15.64-$137.87. Economies of scale were observed in the implementation of ITNs, IRS and IPT, with lower unit costs reported in studies with larger numbers of beneficiaries. From a provider perspective, the median incremental cost effectiveness ratio per disability adjusted life year averted was $27 (range $8.15-$110 for ITNs, $143 (range $135

  10. Cost and cost-effectiveness of conventional and liquid-based ...

    African Journals Online (AJOL)

    Methods. The unit of effectiveness was defined as the number of cervical intraepithelial neoplasm (CIN) II or higher lesions detected. Costs were assessed retrospectively for the financial year (2010/11) from a laboratory service provider perspective. A cost-effectiveness analysis was performed by combining secondary data ...

  11. At What Cost? Examining the Cost Effectiveness of a Universal Social-Emotional Learning Program

    Science.gov (United States)

    Hunter, Leah J.; DiPerna, James C.; Hart, Susan Crandall; Crowley, Max

    2018-01-01

    Although implementation of universal social-emotional learning programs is becoming more common in schools, few studies have examined the cost-effectiveness of such programs. As such, the purpose of this article is two fold. First, we provide an overview of cost-effectiveness methods for school-based programs, and second, we share results of a…

  12. The effect of DNA recovery on the subsequent quality of latent fingermarks.

    Science.gov (United States)

    Fieldhouse, Sarah; Oravcova, Eliska; Walton-Williams, Laura

    2016-10-01

    The recovery of DNA and fingermark evidence from the same site can be problematic on account of potential contamination from fingermark visualisation techniques, and/or the destructive capability of the DNA recovery method. Forensic investigators are therefore often required to choose which evidence type to recover, or to recover both evidence types from different sites. Research typically documents the effects of fingermark visualisation techniques on the subsequent recovery of DNA, whereas this research has investigated the effects of DNA recovery on the quality of subsequently recovered latent fingermarks. Eccrine rich, sebaceous rich, and 'normal' latent fingermarks were deposited onto five substrates: glass; aluminium; textured plastic; varnished wood; photocopier paper and aged from 4h to 4 weeks. Approximately half of the control fingermarks were developed without DNA recovery on all substrates. The remaining samples were subjected to one of five DNA recovery methods prior to fingermark development. Pre and post DNA recovered fingermarks were graded for quality, and AFIS correlations scores were obtained and analysed for statistically significant differences using Wilcoxon Signed Rank tests and Friedman tests. All of the DNA recovery methods reduced the quality of latent fingermarks on glass surfaces. Flocked swabs and gel lifts were the least destructive DNA recovery methods on the remaining surfaces, except for aluminium sheet metal. The quality of latent fingermarks deposited onto glossed wood and textured plastic and paper were less affected by dry swabbing. Wet swabbing and tape lifting were very damaging methods of DNA recovery. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Diet-dependent heat emission reveals costs of post-diapause recovery from different nutritional sources in a carnivorous beetle.

    Science.gov (United States)

    Toft, Søren; Nielsen, Søren Achim

    2017-08-01

    Restoration of fat stores is metabolic first priority for many insects that emerge from hibernation with depleted fat bodies. To some extent, the animals must be flexible and use whatever foods available irrespective of their nutrient composition. Previously, the carabid beetles Anchomenus dorsalis have been found to refill their fat stores to the same extent over 9 days irrespective of the nutrient composition of their food. However, a higher cost of fat deposition when the food was rich in sugar or protein rather than lipid was indicated by higher total energy consumption. Here, we test the hypothesis of increased metabolic costs of building fat stores from sugar- or protein-rich food than from lipid-rich food by microcalorimetry. We measured the heat emitted from beetles that had fed on sugar-, protein-, or lipid-rich food for 0 (common control), 2, 5, or 10 days. As predicted, heat emission was increased in beetles getting sugar- and protein-rich food compared with those getting lipid-rich food. However, we did not confirm the beetles' ability to rebuild fat stores from protein-rich food; instead, they increased in lean mass. Overall, sugar-rich food seems to be optimal for post-winter recovery, because it is better than lipid-rich food that allows concurrent rebuilding of fat stores and lean mass, which may benefit preparation for spring migration and reproduction. We propose that overwintered fruits may be highly preferred post-diapause food for these otherwise mostly carnivorous beetles.

  14. Prospects for Increased Energy Recovery from Horse Manure—A Case Study of Management Practices, Environmental Impact and Costs

    Directory of Open Access Journals (Sweden)

    Åsa Hadin

    2017-11-01

    Full Text Available A transition to renewable energy sources and a circular economy has increased interest in renewable resources not usually considered as energy sources or plant nutrient resources. Horse manure exemplifies this, as it is sometimes recycled but not often used for energy purposes. The purpose of this study was to explore horse manure management in a Swedish municipality and prospects for energy recovery. The case study includes a survey of horse manure practices, environmental assessment of horse manure treatment in a biogas plant, including associated transport, compared to on-site unmanaged composting, and finally a simplified economic analysis. It was found that horse manure management was characterized by indoor collection of manure most of the year and storage on concrete slabs or in containers, followed by direct application on arable land. Softwood was predominantly used as bedding, and bedding accounted for a relatively small proportion (13% of the total mix. Anaerobic digestion was indicated to reduce potential environmental impact in comparison to unmanaged composting, mainly due to biogas substituting use of fossil fuels. The relative environmental impact from transport of manure from horse facilities to anaerobic digestion plant was small. Results also indicate a relatively high cost for horse keepers to change from composting on site to anaerobic digestion in a centralized plant.

  15. Setting-up a cost recovery system for the largest wastewater treatment plant in South-East Asia.

    Science.gov (United States)

    Lønholdt, J; Elberg Jørgensen, P; O'Hearn, D

    2005-01-01

    A tariff system has been set up for the largest wastewater treatment plant in South-East Asia, the Samut Prakarn Wastewater Treatment Plant south of Bangkok, which is currently under completion. Fully functional the plant will have a design capacity for 500,000 m3 per day and will service a combined residential and industrial area with approximately 600,000 residents and 2,300 factories. The tariff system, which includes a tariff model, is based on water consumption and BOD load. As background for setting the tariffs a comprehensive monitoring system including an industrial permitting system has been developed. The paper presents the background and rationale for setting up the system as well as the objective, scope and content of the tariff system and the industrial permit system. Further, the feasibility of introducing cost recovery systems, which is widely accepted in developing economies on the conceptual level and to some extent implemented at the legal and regulatory level, but has yet to be implemented at large, is discussed.

  16. Evaluation of Reservoir Wettability and its Effect on Oil Recovery

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, Jill S.

    2002-01-29

    The objectives of this five-year project were: (1) to achieve improved understanding of the surface and interfacial properties of crude oils and their interactions with mineral surfaces, (2) to apply the results of surface studies to improve predictions of oil production from laboratory measurements, and (3) to use the results of this research to recommend ways to improve oil recovery by waterflooding.

  17. Statin cost effectiveness in primary prevention: A systematic review of the recent cost-effectiveness literature in the United States

    Directory of Open Access Journals (Sweden)

    Mitchell Aaron P

    2012-07-01

    Full Text Available Abstract Background The literature on the cost-effectiveness of statin drugs in primary prevention of coronary heart disease is complex. The objective of this study is to compare the disparate results of recent cost-effectiveness analyses of statins. Findings We conducted a systematic review of the literature on statin cost-effectiveness. The four studies that met inclusion criteria reported varying conclusions about the cost-effectiveness of statin treatment, without a clear consensus as to whether statins are cost-effective for primary prevention. However, after accounting for each study’s assumptions about statin costs, we found substantial agreement among the studies. Studies that assumed statins to be more expensive found them to be less cost-effective, and vice-versa. Furthermore, treatment of low-risk groups became cost-effective as statins became less expensive. Conclusions Drug price is the primary determinant of statin cost-effectiveness within a given risk group. As more statin drugs become generic, patients at low risk for coronary disease may be treated cost-effectively. Though many factors must be weighed in any medical decision, from a cost-effectiveness perspective, statins may now be considered an appropriate therapy for many patients at low risk for heart disease.

  18. Cost effectiveness methodology for evaluating Korean international communication system alternatives.

    OpenAIRE

    Hwang, Tae Kyun.

    1987-01-01

    Approved for public release; distribution in unlimited. Cost and Effectiveness models are developed by using of cost-effectiveness technique for fiber optic cable and satellite communication media. The models are applied to the Korean international communication problem. Alternative selection is required since the two medias different in cost and effectiveness. The major difficulties encountered were data gathering and measuring the effectiveness of the Korean international ...

  19. Global cost-effectiveness of GDM screening and management

    DEFF Research Database (Denmark)

    Weile, Louise K K; Kahn, James G; Marseille, Elliot

    2015-01-01

    a systematic search and abstraction of cost-effectiveness and cost-utility studies from 2002 to 2014. We standardized all findings to 2014 US dollars. We found that cost-effectiveness ratios varied widely. Most variation was found to be due to differences in geographic setting, diagnostic criteria...... and intervention approaches, and outcomes (e.g., inclusion or exclusion of long-term type 2 diabetes risk and associated costs). We concluded that incorporation of long-term benefits of GDM screening and treatment has huge impact on cost-effectiveness estimates. Based on the large methodological heterogeneity...

  20. Costs and cost-effectiveness of pediatric inguinal hernia repair in Uganda.

    Science.gov (United States)

    Eeson, Gareth; Birabwa-Male, Doreen; Pennington, Mark; Blair, Geoffrey K

    2015-02-01

    Surgically treatable diseases contribute approximately 11% of disability-adjusted life years (DALYs) worldwide yet they remain a neglected public health priority in low- and middle-income countries (LMICs). Pediatric inguinal hernia is the most common congenital abnormality in newborns and a major cause of morbidity and mortality yet elective repair remains largely unavailable in LMICs. This study is aimed to determine the costs and cost-effectiveness of pediatric inguinal hernia repair (PIHR) in a low-resource setting. Medical costs of consecutive elective PIHRs were recorded prospectively at two centers in Uganda. Decision modeling was used to compare two different treatment scenarios (adoption of PIHR and non-adoption) from a provider perspective. A Markov model was constructed to estimate health outcomes under each scenario. The robustness of the cost-effectiveness results in the base case analysis was tested in one-way and probabilistic sensitivity analysis. The primary outcome of interest was cost per DALY averted by the intervention. Sixty-nine PIHRs were performed in 65 children (mean age 3.6 years). Mean cost per procedure was $86.68 US (95% CI 83.1-90.2 USD) and averted an average of 5.7 DALYs each. Incremental cost-effectiveness ratio was $12.41 per DALY averted. The probability of cost-effectiveness was 95% at a cost-effectiveness threshold of $35 per averted DALY. Results were robust to sensitivity analysis under all considered scenarios. Elective PIHR is highly cost-effective for the treatment and prevention of complications of hernia disease even in low-resource settings. PIHR should be prioritized in LMICs alongside other cost-effective interventions.

  1. A review on cost-effectiveness and cost-utility of psychosocial care in cancer patients

    Directory of Open Access Journals (Sweden)

    Femke Jansen

    2016-01-01

    Full Text Available Several psychosocial care interventions have been found effective in improving psychosocial outcomes in cancer patients. At present, there is increasingly being asked for information on the value for money of this type of intervention. This review therefore evaluates current evidence from studies investigating cost-effectiveness or cost-utility of psychosocial care in cancer patients. A systematic search was conducted in PubMed and Web of Science yielding 539 unique records, of which 11 studies were included in the study. Studies were mainly performed in breast cancer populations or mixed cancer populations. Studied interventions included collaborative care (four studies, group interventions (four studies, individual psychological support (two studies, and individual psycho-education (one study. Seven studies assessed the cost-utility of psychosocial care (based on quality-adjusted-life-years while three studies investigated its cost-effectiveness (based on profile of mood states [mood], Revised Impact of Events Scale [distress], 12-Item Health Survey [mental health], or Fear of Progression Questionnaire [fear of cancer progression]. One study did both. Costs included were intervention costs (three studies, intervention and direct medical costs (five studies, or intervention, direct medical, and direct nonmedical costs (three studies. In general, results indicated that psychosocial care is likely to be cost-effective at different, potentially acceptable, willingness-to-pay thresholds. Further research should be performed to provide more clear information as to which psychosocial care interventions are most cost-effective and for whom. In addition, more research should be performed encompassing potential important cost drivers from a societal perspective, such as productivity losses or informal care costs, in the analyses.

  2. Cost-of-illness studies and cost-effectiveness analyses in anxiety disorders: a systematic review.

    Science.gov (United States)

    Konnopka, Alexander; Leichsenring, Falk; Leibing, Eric; König, Hans-Helmut

    2009-04-01

    To review cost-of-illness studies (COI) and cost-effectiveness analyses (CEA) conducted for anxiety disorders. Based on a database search in Pubmed, PsychINFO and NHS EED, studies were classified according to various criteria. Cost data were inflated and converted to 2005 US-$ purchasing power parities (PPP). We finally identified 20 COI and 11 CEA of which most concentrated on panic disorder (PD) and generalized anxiety disorder (GAD). Differing inclusion of cost categories limited comparability of COI. PD and GAD tended to show higher direct costs per case, but lower direct cost per inhabitant than social and specific phobias. Different measures of effectiveness severely limited comparability of CEA. Overall CEA analysed 26 therapeutic or interventional strategies mostly compared to standard treatment, 8 of them resulting in lower better effectiveness and costs than the comparator. Anxiety disorders cause considerable costs. More research on phobias, more standardised inclusion of cost categories in COI and a wider use of comparable effectiveness measures (like QALYs) in CEA is needed.

  3. Cost effectiveness and efficiency in assistive technology service delivery.

    Science.gov (United States)

    Warren, C G

    1993-01-01

    In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

  4. The cost-effectiveness of psychotherapy for the major psychiatric diagnoses.

    Science.gov (United States)

    Lazar, Susan G

    2014-09-01

    Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need

  5. Cost Recovery Data Set

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act) requires NOAA’s National Marine Fisheries Service (NMFS) to collect fees to...

  6. Design of cost effective antennas for instrumentation radars

    CSIR Research Space (South Africa)

    Botha, L

    2012-09-01

    Full Text Available The cost of antennas for instrumentation radars are determined by the development cost. By re-use of the reflector system cost effective antennas can be designed. The factors governing the design of such antennas are described here....

  7. An Assessment Of The Effectiveness Of Collaborative Cost ...

    African Journals Online (AJOL)

    This paper presents the effects of Collaborative Cost Reduction Model (CCRM) as a control Approach to reduce the high cost implication that causes the slow pace of migration process from IPV4 to IPV6 in Nigeria. This study reveals that CCRM can be applied to achieve Cost Reduction in collocation efforts in ...

  8. Cost-effectiveness of rotavirus vaccination in Turkey

    Directory of Open Access Journals (Sweden)

    Tulin Koksal

    2017-10-01

    Conclusion: At a cost per vaccine course of US$31.5 for monovalent and US$38 for pentavalent vaccine, routine RV vaccination could be potentially cost effective and also cost saving in Turkey. National RV vaccinations will play a significant role in preventing RV infections.

  9. Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation.

    Science.gov (United States)

    Chhagan, Meera K; Van den Broeck, Jan; Luabeya, Kany-Kany Angelique; Mpontshane, Nontobeko; Bennish, Michael L

    2014-09-01

    To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

  10. Cost-effectiveness and the socialization of health care.

    Science.gov (United States)

    Musgrove, P

    1995-01-01

    The more health care is socialized, the more cost-effectiveness is an appropriate criterion for expenditure. Utility-maximizing individuals, facing divisibility of health care purchases and declining marginal health gains, and complete information about probable health improvements, should buy health care according to its cost-effectiveness. Absent these features, individual health spending will not be cost-effective; and in any case, differences in personal utilities and risk aversion will not lead to the same ranking of health care interventions for everyone. Private insurance frees consumers from concern for cost, which undermines cost-effectiveness, but lets them emphasize effectiveness, which favors value for money. This is most important for costly and cost-effective interventions, especially for poor people. Cost-effectiveness is more appropriate and easier to achieve under second-party insurance. More complete socialization of health care, via public finance, can yield greater efficiency by making insurance compulsory. Cost-effectiveness is also more attractive when taxpayers subsidize others' care: needs (effectiveness) take precedence over wants (utility). The gain in effectiveness may be greater, and the welfare loss from Pareto non-optimality smaller, in poor countries than in rich ones.

  11. The effect of costs on the future of nuclear power

    International Nuclear Information System (INIS)

    Walske, C.

    1984-01-01

    The author discusses the future of the nuclear power industry from an economics and cost-factor point of view, from the point of view of plant management, as it affects and requires personnel training, as R and D cost and competition is involved, as end-user cost is involved, and as efficiency and cost effectiveness of nuclear power fare in comparison with other sources of electrical energy

  12. Planning tiger recovery: Understanding intraspecific variation for effective conservation

    OpenAIRE

    Wilting, Andreas; Courtiol, Alexandre; Christiansen, Per; Niedballa, J?rgen; Scharf, Anne K.; Orlando, Ludovic; Balkenhol, Niko; Hofer, Heribert; Kramer-Schadt, Stephanie; Fickel, J?rns; Kitchener, Andrew C.

    2015-01-01

    Although significantly more money is spent on the conservation of tigers than on any other threatened species, today only 3200 to 3600 tigers roam the forests of Asia, occupying only 7% of their historical range. Despite the global significance of and interest in tiger conservation, global approaches to plan tiger recovery are partly impeded by the lack of a consensus on the number of tiger subspecies or management units, because a comprehensive analysis of tiger variation is lacking. We anal...

  13. The Kyoto Protocol Is Cost-effective

    Directory of Open Access Journals (Sweden)

    Marino Gatto

    2002-06-01

    Full Text Available Despite recent advances, there is a high degree of uncertainty concerning the climate change that would result from increasing atmospheric greenhouse gas concentrations. Also, opponents of the Kyoto Protocol raised the key objection that reducing emissions would impose an unacceptable economic burden on businesses and consumers. Based on an analysis of alternative scenarios for electricity generation in Italy, we show that if the costs in terms of damage to human health, material goods, agriculture, and the environment caused by greenhouse gas emissions are included in the balance, the economic argument against Kyoto is untenable. Most importantly, the argument holds true even if we exclude global external costs (those due to global warming, and account for local external costs only (such as those due to acidic precipitation and lung diseases resulting from air pollution.

  14. Cost effectiveness of dilute chemical decontamination

    International Nuclear Information System (INIS)

    Le Surf, J.E.; Weyman, G.D.

    1983-01-01

    The origin and basic principles of the dilute chemical decontamination (DCD) concept are described and illustrated by reference to the CAN-DECON process. The estimated dose savings from the actual application of the process at several reactors are presented and discussed. Two methods of performing a cost/benefit appraisal are described and discussed. This methodology requires more study by the nuclear industry, including collection by station staff of relevant data on which future cost/benefit appraisals may be based. Finally, three illustrative cases are examinated to show the breakeven point and potential savings achievable by DCD with different initial radiation fields and different amounts of work to be done. The overall conclusion is that there are many situations in which DCD is desirable to reduce radiation exposure of workers, to save costs to the station, and to ease the performance of maintenance and repair work on reactor systems

  15. [Cost effectiveness in treatment of acute myeloid leukemia].

    Science.gov (United States)

    Nordmann, P; Schaffner, A; Dazzi, H

    2000-12-23

    Although the rise in health costs is a widely debated issue, in Switzerland it was until recently taken for granted that patients are given the best available treatment regardless of cost. An example of a disease requiring costly treatment is acute myelogenous leukaemia (AML). To relate cost to benefit we calculated expenditure per life years gained. To assess costs we determined the real cost of treatment up to total remission, followed by consolidation or withdrawal of treatment or death. For survival time exceeding the 2-year observation period we used data from recent literature. The average cost of treatment ranges up to 107,592 Swiss francs (CHF). In 1997 we treated 23 leukaemia patients at Zurich University Hospital and gained a total of 210 life years. This represents an average cost of CHF 11,741 per life year gained. Chief cost items were therapy and personnel costs for nursing staff, followed by hotel business and personnel costs for doctors and diagnosis. Our results for AML treatment are far removed from the $61,500 ranging up to $166,000 discussed in the literature as the "critical" QALY (quality adjusted life years) value. This is the first time the actual costs of AML therapy have been shown for a Swiss cohort. Despite high initial treatment costs and success only in a limited number of patients, the expenditure per QALY is surprisingly low and shows clearly the effectiveness of apparently costly acute medicine.

  16. Cost-effectiveness, feed utilization and body composition of african ...

    African Journals Online (AJOL)

    Cost-effectiveness, feed utilization and body composition of african sharptooth catfish ( Clarias gariepinus , Burchell 1822) fingerlings fed locally formulated and commercial pelleted diets in tarpaulin tanks.

  17. The relationship between cost system complexity, purposes of use, and cost system effectiveness

    NARCIS (Netherlands)

    Schoute, M.

    2009-01-01

    This paper uses survey data from 133 Dutch, medium-sized manufacturing firms to examine the associations between cost system complexity (in terms of the applied overhead absorption procedures), purposes of use, and cost system effectiveness. First, factor analysis identifies two underlying

  18. Cost-effective management alternatives for Snake River Chinook salmon: a biological-economic synthesis.

    Science.gov (United States)

    Halsing, David L; Moore, Michael R

    2008-04-01

    The mandate to increase endangered salmon populations in the Columbia River Basin of North America has created a complex, controversial resource-management issue. We constructed an integrated assessment model as a tool for analyzing biological-economic trade-offs in recovery of Snake River spring- and summer-run chinook salmon (Oncorhynchus tshawytscha). We merged 3 frameworks: a salmon-passage model to predict migration and survival of smolts; an age-structured matrix model to predict long-term population growth rates of salmon stocks; and a cost-effectiveness analysis to determine a set of least-cost management alternatives for achieving particular population growth rates. We assessed 6 individual salmon-management measures and 76 management alternatives composed of one or more measures. To reflect uncertainty, results were derived for different assumptions of effectiveness of smolt transport around dams. Removal of an estuarine predator, the Caspian Tern (Sterna caspia), was cost-effective and generally increased long-term population growth rates regardless of transport effectiveness. Elimination of adult salmon harvest had a similar effect over a range of its cost estimates. The specific management alternatives in the cost-effective set depended on assumptions about transport effectiveness. On the basis of recent estimates of smolt transport effectiveness, alternatives that discontinued transportation or breached dams were prevalent in the cost-effective set, whereas alternatives that maximized transportation dominated if transport effectiveness was relatively high. More generally, the analysis eliminated 80-90% of management alternatives from the cost-effective set. Application of our results to salmon management is limited by data availability and model assumptions, but these limitations can help guide research that addresses critical uncertainties and information. Our results thus demonstrate that linking biology and economics through integrated models can

  19. Atomoxetine's Effect on Societal Costs in Sweden

    Science.gov (United States)

    Myren, Karl-Johan; Thernlund, Gunilla; Nylen, Asa; Schacht, Alexander; Svanborg, Par

    2010-01-01

    Objective: To compare societal costs between patients treated with atomoxetine and placebo in Sweden. Method: Ninety-nine pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (n = 49) or placebo (n = 50). All parents received four sessions of psycho-education. Parents filled out a resource utilization…

  20. Cost, production and effectiveness of masticated fireline.

    Science.gov (United States)

    Elizabeth Dodson; Dana Mitchell

    2016-01-01

    Fire managers are continuously looking for improved methods to construct fireline with minimal resource damage. One option for fireline construction that has so far received limited attention is the use of mastication equipment. This study evaluated a masticating disk mounted on a self-leveling feller- buncher for the cost, speed, and adherence to fireline...

  1. Cost effectiveness of dilute chemical decontamination

    International Nuclear Information System (INIS)

    LeSurf, J.E.; Weyman, G.D.

    The basic principles of dilute chemical decontamination are described, as well as the method of application. Methods of computing savings in radiation dose and costs are presented, with results from actual experience and illustrative examples. It is concluded that dilute chemical decontamination is beneficial in many cases. It reduces radiation exposure of workers, saves money, and simplifies maintenance work

  2. Costs and benefits of biogas recovery from communal anaerobic digesters treating domestic wastewater: Evidence from peri-urban Zambia.

    Science.gov (United States)

    Laramee, Jeannette; Tilmans, Sebastien; Davis, Jennifer

    2018-03-15

    Communal anaerobic digesters (ADs) have been promoted as a waste-to-energy strategy that can provide sanitation and clean energy co-benefits. However, little empirical evidence is available regarding the performance of such systems in field conditions. This study assesses the wastewater treatment efficiency, energy production, greenhouse gas (GHG) emissions, and financial costs and benefits of communal ADs used for domestic wastewater treatment in Zambia. Primary data on the technical performance of 15 ADs were collected over a 6-month period and in-person interviews were conducted with heads of 120 households. Findings from this study suggest that ADs offer comparable wastewater treatment efficiencies and greater GHG emission reduction benefits relative to conventional septic tanks (STs), with the greatest benefits in settings with reliable access to water, use of low efficiency solid fuels and with sufficient demand for biogas in proximity to supply. However, absent a mechanism to monetize additional benefits from biogas recovery, ADs in this context will not be a financially attractive investment relative to STs. Our financial analysis suggests that, under the conditions in this study, a carbon price of US$9 to $28 per tCO 2 e is necessary for positive investment in ADs relative to STs. Findings from this study contribute empirical evidence on ADs as a sanitation and clean energy strategy, identify conditions under which the greatest benefits are likely to accrue and inform international climate efforts on the carbon price required to attract investment in emissions reduction projects such as ADs. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Investigation of the strontium (Sr(II)) adsorption of an alginate microsphere as a low-cost adsorbent for removal and recovery from seawater.

    Science.gov (United States)

    Hong, Hye-Jin; Ryu, Jungho; Park, In-Su; Ryu, Taegong; Chung, Kang-Sup; Kim, Byuong-Gyu

    2016-01-01

    In this paper, we investigated alginate microspheres as a low-cost adsorbent for strontium (Sr(II)) removal and recovery from seawater. Alginate microspheres have demonstrated a superior adsorption capacity for Sr(II) ions (≈110 mg/g). A Freundlich isotherm model fits well with the Sr(II) adsorption of an alginate microsphere. The mechanism of Sr(II) adsorption is inferred as an ion exchange reaction with Ca(II) ions. The effects of the solution pH and co-existing ions in seawater are also investigated. Except for a pH of 1-2, Sr(II) adsorption capacity is not affected by pH. However, increasing the seawater concentration of metal cations seriously decreases Sr(II) uptake. In particular, highly concentrated (15,000 mg/L) Na(I) ions significantly interfere with Sr(II) adsorption. Sr(II) desorption was performed using 0.1 M HCl and CaCl2. Both regenerants show an excellent desorption efficiency, but the FTIR spectrum reveals that the chemical structure of the microsphere is destroyed after repeated use of HCl. Conversely, CaCl2 successfully desorbed Sr(II) without damage, and the Sr(II) adsorption capacity does not decrease after three repeated uses. The alginate microsphere was also applied to the adsorption of Sr(II) in a real seawater medium. Because of inhibition by co-existing ions, the Sr(II) adsorption capacity was decreased and the adsorption rate was retarded compared with D.I. water. Although the Sr(II) adsorption capacity was decreased, the alginate microsphere still exhibited 17.8 mg/g of Sr(II) uptake in the seawater medium. Considering its excellent Sr(II) uptake in seawater and its reusability, an alginate microsphere is an appropriate cost-effective adsorbent for the removal and recovery of Sr(II) from seawater. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. A quantitative method to evaluate microbial electrolysis cell effectiveness for energy recovery and wastewater treatment

    KAUST Repository

    Ivanov, Ivan; Ren, Lijiao; Siegert, Michael; Logan, Bruce E.

    2013-01-01

    Microbial electrolysis cells (MECs) are potential candidates for sustainable wastewater treatment as they allow for recovery of the energy input by producing valuable chemicals such as hydrogen gas. Evaluating the effectiveness of MEC treatment

  5. Cost effectiveness analysis of indoor radon control measures

    International Nuclear Information System (INIS)

    Fujimoto, Kenzo

    1989-01-01

    The problem of radon 222 in buildings as a contributor to radiation exposure is described. Five different control methods and the dose reductions that would result from each are analysed. The annualized cost for each control measure was evaluated and the cost effectiveness of each control measure was calculated on the basis of dollars per person-sievert dose reduction. The use of unipolar ion generators for particle removal appears to be the most cost effective and the use of ceiling fans to increase air circulation the least cost effective. 3 figs., 1 tab

  6. Psychophysiological effects of music on acute recovery from high-intensity interval training

    OpenAIRE

    Jones, L; Tiller, NB; Karageorghis, CI

    2016-01-01

    Numerous studies have examined the multifarious effects of music applied during exercise but few have assessed the efficacy of music as an aid to recovery. Music might facilitate physiological recovery via the entrainment of respiratory rhythms with music tempo. High-intensity exercise training is not typically associated with positive affective responses, and thus ways of assuaging negative affect warrant further exploration. This study assessed the psychophysiological effects of music on ac...

  7. The Effects of Electrostimulation and Core Exercises on Recovery After High-Intensity Exercise

    Directory of Open Access Journals (Sweden)

    Ahmet Mor

    2017-12-01

    Full Text Available Introduction and objectives: The purpose of this study was to determine the effects of electrostimulation and core exercises on recovery after high-intensity exercise. Methods: The participants of this study consists of 12 male bodybuilders who regularly train and between the ages 18-30. Tabata high intensity interval training (HIIT was applied with different recovery methods to the athletes on three different days and the recovery levels of athletes were analysed. Heart rate and blood lactate levels were measured at baseline (PRE at immediately after the HIIT (POST, at the 1 minutes after HIIT (1min, at the 5 minutes after HIIT (5min, and at the 10 minutes after HIIT (10min. On the rest days, serum lactate dehydrogenase (LDH and serum creatine kinase (CK  measurements were done to determine the muscle damage. Results: The in-group comparisons for lactate levels showed no significant difference (p>0,01. The level of lactate on the 10min was found to be significantly lower than the 5min in the core exercise group (p0,01. These results show that the lactate level reaches to the maximum level after HIIT, and the level of lactate decreases between the 5th and the 10th minutes. Discussion and conclusion: These indicate that the active recovery methods are more effective than the passive. It was found that the active recovery methods accelerate the lactate removal from the metabolism and provide effective recovery in short time during the recovery period after exercise.

  8. Effect of different musical tempo on post-exercise recovery in young adults.

    Science.gov (United States)

    Savitha, D; Mallikarjuna, Reddy N; Rao, Chythra

    2010-01-01

    The role of music in increasing the exercise performance is well recognised. There is very little information about effect of music on time taken for post exercise recovery. We examined the effect of music and different musical tempo on post exercise recovery time, following treadmill work. 30 volunteers (15 male, 15 female) subjected to isotonic exercise (submaximal treadmill work) on three consecutive days. They were allowed to rest in silence on the first day, rest by hearing slow music on second day and rest with fast music on third day. Parameters such as Pulse rate, blood pressure, rating of perceived exertion (RPE) were measured at predetermined intervals. Repeated measures ANOVA test showed that with slow music, recovery time of systolic blood pressure (SBP) (7.9 +/- 2.5), diastolic blood pressure (DBP) (5.5 +/- 3.4) pulse rate recovery (PR) (8.0 +/- 2.3) and recovery from exertion (RPE) (7.7 +/- 2.5) were significantly faster when compared to both no music and fast music. The individual music preference made no significant difference in the relaxation time. The study concluded that music hastens post exercise recovery and slow music has greater relaxation effect than fast or no music, recovery time being independent of the gender and individual music preference.

  9. Bioenergy, material, and nutrients recovery from household waste: Advanced material, substance, energy, and cost flow analysis of a waste refinery process

    International Nuclear Information System (INIS)

    Tonini, Davide; Dorini, Gianluca; Astrup, Thomas Fruergaard

    2014-01-01

    Highlights: • We modeled material, substance, energy, and cost flows of a waste refinery process. • Ca. 56% of 1 Mg dry waste input can be recovered as bioliquid yielding 6.2 GJ biogas. • Nutrients and carbon recovery in the bioliquid was estimated to 81–89%. • The biogenic carbon in the input waste was 63% of total carbon based on 14 C analyses. • The quality of the digestate may be critical with respect to use on land. - Abstract: Energy, materials, and resource recovery from mixed household waste may contribute to reductions in fossil fuel and resource consumption. For this purpose, legislation has been enforced to promote energy recovery and recycling. Potential solutions for separating biogenic and recyclable materials are offered by waste refineries where a bioliquid is produced from enzymatic treatment of mixed waste. In this study, potential flows of materials, energy, and substances within a waste refinery were investigated by combining sampling, analyses, and modeling. Existing material, substance, and energy flow analysis was further advanced by development of a mathematical optimization model for determination of the theoretical recovery potential. The results highlighted that the waste refinery may recover ca. 56% of the dry matter input as bioliquid, yielding 6.2 GJ biogas-energy. The potential for nitrogen, phosphorous, potassium, and biogenic carbon recovery was estimated to be between 81% and 89% of the input. Biogenic and fossil carbon in the mixed household waste input was determined to 63% and 37% of total carbon based on 14 C analyses. Additional recovery of metals and plastic was possible based on further process optimization. A challenge for the process may be digestate quality, as digestate may represent an emission pathway when applied on land. Considering the potential variability of local revenues for energy outputs, the costs for the waste refinery solution appeared comparable with alternatives such as direct incineration

  10. Cost-effectiveness of antiplatelet drugs after percutaneous coronary intervention.

    Science.gov (United States)

    Wisløff, Torbjørn; Atar, Dan

    2016-01-01

    Clopidogrel has, for long time, been accepted as the standard treatment for patients who have undergone a percutaneous coronary intervention (PCI). The introduction of prasugrel-and more recently, ticagrelor-has introduced a decision-making problem for clinicians and governments worldwide: to use the cheaper clopidogrel or the more effective, and also more expensive prasugrel or ticagrelor. We aim to give helpful contributions to this debate by analysing the cost-effectiveness of clopidogrel, prasugrel, and ticagrelor compared with each other. We modified a previously developed Markov model of cardiac disease progression. In the model, we followed up cohorts of patients who have recently had a PCI until 100 years or death. Possible events are revascularization, bleeding, acute myocardial infarction, and death. Our analysis shows that ticagrelor is cost-effective in 77% of simulations at an incremental cost-effectiveness ratio of €7700 compared with clopidogrel. Ticagrelor was also cost-effective against prasugrel at a cost-effectiveness ratio of €7800. Given a Norwegian cost-effectiveness threshold of €70 000, both comparisons appear to be clearly cost-effective in favour of ticagrelor. Ticagrelor is cost-effective compared with both clopidogrel and prasugrel for patients who have undergone a PCI.

  11. Cost-effectiveness of Chlamydia antibody tests in subfertile women.

    Science.gov (United States)

    Fiddelers, A A A; Land, J A; Voss, G; Kessels, A G H; Severens, J L

    2005-02-01

    For the evaluation of tubal function, Chlamydia antibody testing (CAT) has been introduced as a screening test. We compared six CAT screening strategies (five CAT tests and one combination of tests), with respect to their cost-effectiveness, by using IVF pregnancy rate as outcome measure. A decision analytic model was developed based on a source population of 1715 subfertile women. The model incorporates hysterosalpingography (HSG), laparoscopy and IVF. To calculate IVF pregnancy rates, costs, effects, cost-effectiveness and incremental costs per effect of the six different CAT screening strategies were determined. pELISA Medac turned out to be the most cost-effective CAT screening strategy (15 075 per IVF pregnancy), followed by MIF Anilabsystems (15 108). A combination of tests (pELISA Medac and MIF Anilabsystems; 15 127) did not improve the cost-effectiveness of the single strategies. Sensitivity analyses showed that the results are robust for changes in the baseline values of the model parameters. Only small differences were found between the screening strategies regarding the cost-effectiveness, although pELISA Medac was the most cost-effective strategy. Before introducing a particular CAT test into clinical practice, one should consider the effects and consequences of the entire screening strategy, instead of only the diagnostic accuracy of the test used.

  12. Cost effective campaigning in social networks

    Science.gov (United States)

    Kotnis, Bhushan; Kuri, Joy

    2016-05-01

    Campaigners are increasingly using online social networking platforms for promoting products, ideas and information. A popular method of promoting a product or even an idea is incentivizing individuals to evangelize the idea vigorously by providing them with referral rewards in the form of discounts, cash backs, or social recognition. Due to budget constraints on scarce resources such as money and manpower, it may not be possible to provide incentives for the entire population, and hence incentives need to be allocated judiciously to appropriate individuals for ensuring the highest possible outreach size. We aim to do the same by formulating and solving an optimization problem using percolation theory. In particular, we compute the set of individuals that are provided incentives for minimizing the expected cost while ensuring a given outreach size. We also solve the problem of computing the set of individuals to be incentivized for maximizing the outreach size for given cost budget. The optimization problem turns out to be non trivial; it involves quantities that need to be computed by numerically solving a fixed point equation. Our primary contribution is, that for a fairly general cost structure, we show that the optimization problems can be solved by solving a simple linear program. We believe that our approach of using percolation theory to formulate an optimization problem is the first of its kind.

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

    Science.gov (United States)

    Savitz, Lucy A; Savitz, Samuel T

    2016-01-01

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

  14. Cost-effectiveness of open versus arthroscopic rotator cuff repair.

    Science.gov (United States)

    Adla, Deepthi N; Rowsell, Mark; Pandey, Radhakant

    2010-03-01

    Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears. This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data. At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was pound675 ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular. Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results. Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  15. Cost-effectiveness analysis of sandhill crane habitat management

    Science.gov (United States)

    Kessler, Andrew C.; Merchant, James W.; Shultz, Steven D.; Allen, Craig R.

    2013-01-01

    Invasive species often threaten native wildlife populations and strain the budgets of agencies charged with wildlife management. We demonstrate the potential of cost-effectiveness analysis to improve the efficiency and value of efforts to enhance sandhill crane (Grus canadensis) roosting habitat. We focus on the central Platte River in Nebraska (USA), a region of international ecological importance for migrating avian species including sandhill cranes. Cost-effectiveness analysis is a valuation process designed to compare alternative actions based on the cost of achieving a pre-determined objective. We estimated costs for removal of invasive vegetation using geographic information system simulations and calculated benefits as the increase in area of sandhill crane roosting habitat. We generated cost effectiveness values for removing invasive vegetation on 7 land parcels and for the entire central Platte River to compare the cost-effectiveness of management at specific sites and for the central Platte River landscape. Median cost effectiveness values for the 7 land parcels evaluated suggest that costs for creating 1 additional hectare of sandhill crane roosting habitat totaled US $1,595. By contrast, we found that creating an additional hectare of sandhill crane roosting habitat could cost as much as US $12,010 for some areas in the central Platte River, indicating substantial cost savings can be achieved by using a cost effectiveness analysis to target specific land parcels for management. Cost-effectiveness analysis, used in conjunction with geographic information systems, can provide decision-makers with a new tool for identifying the most economically efficient allocation of resources to achieve habitat management goals.

  16. Cost effectiveness of haemophilia treatment : a cross-national assessment

    NARCIS (Netherlands)

    Lippert, B; Berger, K; Berntorp, E; Giangrande, P; van den Berg, M; Schramm, W; Siebert, U

    2005-01-01

    The aim of this study was to assess the incremental cost effectiveness of on-demand versus prophylactic haemophilia therapy in Germany, Sweden, the United Kingdom and The Netherlands from the third-party payers' perspective. Using a decision tree model, the cost effectiveness of on-demand versus

  17. Index method for analyzing cost effectiveness of drilling rigs

    Energy Technology Data Exchange (ETDEWEB)

    Batura, N P; Bocharov, V V

    1978-01-01

    The method for a complete analysis of the factors determining cost effectiveness of a drilling rig fleet is examined. The system of calculating production indexes from statistical reports is relatively simple and is not difficult to use for production organizations. The analytical results may be used to develop actual measures used to increase cost effectiveness of drilling operations.

  18. Cost-effectiveness of trachoma control in seven world regions.

    NARCIS (Netherlands)

    Baltussen, R.M.P.M.; Sylla, M.; Frick, K.D.; Mariotti, S.P.

    2005-01-01

    BACKGROUND/AIMS: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and

  19. The Cost-Effectiveness of NBPTS Teacher Certification

    Science.gov (United States)

    Yeh, Stuart S.

    2010-01-01

    A cost-effectiveness analysis of the National Board for Professional Teaching Standards (NBPTS) program suggests that Board certification is less cost-effective than a range of alternative approaches for raising student achievement, including comprehensive school reform, class size reduction, a 10% increase in per pupil expenditure, the use of…

  20. Cost-effectiveness analysis of infant feeding strategies to prevent ...

    African Journals Online (AJOL)

    Changing feeding practices is beneficial, depending on context. Breastfeeding is dominant (less costly, more effective) in rural settings, whilst formula feeding is a dominant strategy in urban settings. Cost-effectiveness was most sensitive to proportion of women on lifelong antiretroviral therapy (ART) and infant mortality rate ...

  1. ORIGINAL ARTICLES Cost-effectiveness analysis for priority-setting ...

    African Journals Online (AJOL)

    health outcomes and wasted resources.4-5 It was found that the cost- effectiveness of South ... Priorities for Developing Countries Project was that emergency (and even some elective) ... to control air pollutants found that in South Africa the most cost- effective ..... outdoor air pollution in South Africa in 2000. S Afr Med J ...

  2. The Potential Cost-Effectiveness of Amblyopia Screening Programs

    Science.gov (United States)

    Rein, David B.; Wittenborn, John S.; Zhang, Xinzhi; Song, Michael; Saaddine, Jinan B.

    2013-01-01

    Background To estimate the incremental cost-effectiveness of amblyopia screening at preschool and kindergarten, we compared the costs and benefits of 3 amblyopia screening scenarios to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten. Methods We programmed a probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from 2 state programs. We calculated the probability that no screening and each of the 3 interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided. Results Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective between a WTP of $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective between a WTP of $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured. Conclusions All 3 screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies. PMID:21877675

  3. A systematic review of the cost and cost effectiveness of treatment for multidrug-resistant tuberculosis.

    Science.gov (United States)

    Fitzpatrick, Christopher; Floyd, Katherine

    2012-01-01

    Around 0.4 million cases of multidrug-resistant tuberculosis (MDR-TB) occur each year. Only a small fraction of these cases are treated according to international guidelines. Evidence relevant to decisions about whether to scale-up treatment for MDR-TB includes cost and cost-effectiveness data. Up to 2010, no systematic review of this evidence has been available. Our objective was to conduct a systematic review of the cost and cost effectiveness of treatment for MDR-TB and synthesize the available data. We searched for papers published or prepared for publication in peer-review journals and grey literature using search terms in five languages: English, French, Portuguese, Russian and Spanish. From an initial set of 420 studies, four were included, from Peru, the Philippines, Estonia and Tomsk Oblast in the Russian Federation. Results on costs, effectiveness and cost effectiveness were extracted. Assessment of the quality of each economic evaluation was guided by two existing checklists around which there is broad consensus. Costs were adjusted to a common year of value (2005) to remove distortions caused by inflation, and calculated in two common currencies: $US and international dollars (I$), to standardize for purchasing power parity. Data from the four identified studies were then synthesized using probabilistic sensitivity analysis, to appraise the likely cost and cost effectiveness of MDR-TB treatment in other settings, relative to WHO benchmarks for assessing whether or not an intervention is cost effective. Best estimates are provided as means, with 5th and 95th percentiles of the distributions. The cost per patient for MDR-TB treatment in Estonia, Peru, the Philippines and Tomsk was $US10 880, $US2423, $US3613 and $US14 657, respectively. Best estimates of the cost per disability-adjusted life-year (DALY) averted were $US598 (I$960), $US163 (I$291), $US143 (I$255) and $US745 (I$1059), respectively. The main influences on costs were (i) the model of care

  4. Cost-effectiveness in fall prevention for older women.

    Science.gov (United States)

    Hektoen, Liv F; Aas, Eline; Lurås, Hilde

    2009-08-01

    The aim of this study was to estimate the cost-effectiveness of implementing an exercise-based fall prevention programme for home-dwelling women in the > or = 80-year age group in Norway. The impact of the home-based individual exercise programme on the number of falls is based on a New Zealand study. On the basis of the cost estimates and the estimated reduction in the number of falls obtained with the chosen programme, we calculated the incremental costs and the incremental effect of the exercise programme as compared with no prevention. The calculation of the average healthcare cost of falling was based on assumptions regarding the distribution of fall injuries reported in the literature, four constructed representative case histories, assumptions regarding healthcare provision associated with the treatment of the specified cases, and estimated unit costs from Norwegian cost data. We calculated the average healthcare costs per fall for the first year. We found that the reduction in healthcare costs per individual for treating fall-related injuries was 1.85 times higher than the cost of implementing a fall prevention programme. The reduction in healthcare costs more than offset the cost of the prevention programme for women aged > or = 80 years living at home, which indicates that health authorities should increase their focus on prevention. The main intention of this article is to stipulate costs connected to falls among the elderly in a transparent way and visualize the whole cost picture. Cost-effectiveness analysis is a health policy tool that makes politicians and other makers of health policy conscious of this complexity.

  5. Design and implementation of a cost-effective microscope for fabrication and imaging

    International Nuclear Information System (INIS)

    Trout, G; Basu, S

    2009-01-01

    The use of lasers and optical systems for advanced research and demonstrative purposes has traditionally been cost-prohibitive for many researchers. In this note, we present the design and optimization of a low-cost microscopy setup capable of imaging, fabrication or photopolymerization via multiphoton excitation of a photoactivator and the study of processes such as diffusion using fluorescence recovery after photobleaching (FRAP). The setup features a continuous wave (CW) Ar-ion laser, a pulsed Nd 3+ :YAG laser, an inverted microscope with a CCD camera and appropriate optics. The setup is cost-effective and puts a once-expensive setup within reach of more researchers interested in micron- and sub-micron-scale processes. (technical design note)

  6. Effectiveness of the food recovery at the retailing stage under shelf life uncertainty: An application to Italian food chains

    International Nuclear Information System (INIS)

    Muriana, Cinzia

    2015-01-01

    Highlights: • The food recovery is seen as suitable way to manage food near to its expiry date. • The variability of the products shelf life must be taken into account. • The paper addresses the mathematic modeling of the profit related to food recovery. • The optimal time to withdraw the products is determinant for food recovery. - Abstract: Food losses represent a significant issue affecting food supply chains. The possibility of recovering such products can be seen as an effective way to reduce such a phenomenon, improve supply chain performances and ameliorate the conditions of undernourished people. The topic has been already investigated by a previous paper enforcing the hypothesis of deterministic and constant Shelf Life (SL) of products. However, such a model cannot be properly extended to products affected by uncertainties of the SL as it does not take into account the deterioration costs and loss of profits due to the overcoming of the SL within the cycle time. Thus the present paper presents an extension of the previous one under stochastic conditions of the food quality. Differently from the previous publication, this work represents a general model applicable to all supply chains, especially to those managing fresh products characterized by uncertain SL such as fruits and vegetables. The deterioration costs and loss of profits are included in the model and the optimal time at which to withdraw the products from the shelves as well as the quantities to be shipped at each alternative destination have been determined. A comparison of the proposed model with that reported in the previous publication has been carried out in order to underline the impact of the SL variability on the optimality conditions. The results show that the food recovery strategy in the presence of uncertainty of the food quality is rewarding, even if the optimal profit is lower than that of the deterministic case

  7. Effectiveness of the food recovery at the retailing stage under shelf life uncertainty: An application to Italian food chains

    Energy Technology Data Exchange (ETDEWEB)

    Muriana, Cinzia, E-mail: cinzia.muriana@unipa.it

    2015-07-15

    Highlights: • The food recovery is seen as suitable way to manage food near to its expiry date. • The variability of the products shelf life must be taken into account. • The paper addresses the mathematic modeling of the profit related to food recovery. • The optimal time to withdraw the products is determinant for food recovery. - Abstract: Food losses represent a significant issue affecting food supply chains. The possibility of recovering such products can be seen as an effective way to reduce such a phenomenon, improve supply chain performances and ameliorate the conditions of undernourished people. The topic has been already investigated by a previous paper enforcing the hypothesis of deterministic and constant Shelf Life (SL) of products. However, such a model cannot be properly extended to products affected by uncertainties of the SL as it does not take into account the deterioration costs and loss of profits due to the overcoming of the SL within the cycle time. Thus the present paper presents an extension of the previous one under stochastic conditions of the food quality. Differently from the previous publication, this work represents a general model applicable to all supply chains, especially to those managing fresh products characterized by uncertain SL such as fruits and vegetables. The deterioration costs and loss of profits are included in the model and the optimal time at which to withdraw the products from the shelves as well as the quantities to be shipped at each alternative destination have been determined. A comparison of the proposed model with that reported in the previous publication has been carried out in order to underline the impact of the SL variability on the optimality conditions. The results show that the food recovery strategy in the presence of uncertainty of the food quality is rewarding, even if the optimal profit is lower than that of the deterministic case.

  8. Cost-effective treatment for the couple with infertility.

    Science.gov (United States)

    Van Voorhis, B J; Syrop, C H

    2000-12-01

    Although the evaluation of cost-effective approaches to infertility treatment remains in its infancy, several important principles have emerged from the initial studies in this field. Currently, in treating couples with infertility without tubal disease or severe male-factor infertility, the most cost-effective approach is to start with IUI or superovulation-IUI treatments before resorting to IVF procedures. The woman's age and number of sperm present for insemination are significant factors influencing cost-effectiveness. The influence of certain diagnoses on the cost-effectiveness of infertility treatments requires further study. Even when accounting for the costs associated with multiple gestations and premature deliveries, the cost of IVF decreases within the range of other cost-effective medical procedures and decreases to less than the willingness to pay for these procedures. Indeed, for patients with severe tubal disease, IVF has been found to be more cost-effective than surgical repair. The cost-effectiveness of IVF will likely improve as success rates show continued improvements over the course of time. In addition, usefulness of embryo selection and practices to reduce the likelihood of high-order multiple pregnancies, without reductions in pregnancy rates, will significantly impact cost-effectiveness. The exclusion of infertility treatments from insurance plans is unfortunate and accentuates the importance of physicians understanding the economics of infertility treatment with costs that are often passed directly to the patient. The erroneous economic policies and judgments that have led to inequities in access to infertility health care should not be tolerated.

  9. Effectiveness and cost effectiveness of counselling in primary care.

    Science.gov (United States)

    Bower, P; Rowland, N; Mellor, C l; Heywood, P; Godfrey, C; Hardy, R

    2002-01-01

    Counsellors are prevalent in primary care settings. However, there are concerns about the clinical and cost-effectiveness of the treatments they provide, compared with alternatives such as usual care from the general practitioner, medication or other psychological therapies. To assess the effectiveness and cost effectiveness of counselling in primary care by reviewing cost and outcome data in randomised controlled trials, controlled clinical trials and controlled patient preference trials of counselling interventions in primary care, for patients with psychological and psychosocial problems considered suitable for counselling. The original search strategy included electronic searching of databases (including the CCDAN Register of RCTs and CCTs) along with handsearching of a specialist journal. Published and unpublished sources (clinical trials, books, dissertations, agency reports etc.) were searched, and their reference lists scanned to uncover further controlled trials. Contact was made with subject experts and CCDAN members in order to uncover further trials. For the updated review, searches were restricted to those databases judged to be high yield in the first version of the review: MEDLINE, EMBASE, PSYCLIT and CINAHL, the Cochrane Controlled Trials register and the CCDAN trials register. All controlled trials comparing counselling in primary care with other treatments for patients with psychological and psychosocial problems considered suitable for counselling. Trials completed before the end of June 2001 were included in the review. Data were extracted using a standardised data extraction sheet. The relevant data were entered into the Review Manager software. Trials were quality rated, using CCDAN criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95

  10. Cost-effectiveness analysis of treatments for vertebral compression fractures.

    Science.gov (United States)

    Edidin, Avram A; Ong, Kevin L; Lau, Edmund; Schmier, Jordana K; Kemner, Jason E; Kurtz, Steven M

    2012-07-01

    Vertebral compression fractures (VCFs) can be treated by nonsurgical management or by minimally invasive surgical treatment including vertebroplasty and balloon kyphoplasty. The purpose of the present study was to characterize the cost to Medicare for treating VCF-diagnosed patients by nonsurgical management, vertebroplasty, or kyphoplasty. We hypothesized that surgical treatments for VCFs using vertebroplasty or kyphoplasty would be a cost-effective alternative to nonsurgical management for the Medicare patient population. Cost per life-year gained for VCF patients in the US Medicare population was compared between operated (kyphoplasty and vertebroplasty) and non-operated patients and between kyphoplasty and vertebroplasty patients, all as a function of patient age and gender. Life expectancy was estimated using a parametric Weibull survival model (adjusted for comorbidities) for 858 978 VCF patients in the 100% Medicare dataset (2005-2008). Median payer costs were identified for each treatment group for up to 3 years following VCF diagnosis, based on 67 018 VCF patients in the 5% Medicare dataset (2005-2008). A discount rate of 3% was used for the base case in the cost-effectiveness analysis, with 0% and 5% discount rates used in sensitivity analyses. After accounting for the differences in median costs and using a discount rate of 3%, the cost per life-year gained for kyphoplasty and vertebroplasty patients ranged from $US1863 to $US6687 and from $US2452 to $US13 543, respectively, compared with non-operated patients. The cost per life-year gained for kyphoplasty compared with vertebroplasty ranged from -$US4878 (cost saving) to $US2763. Among patients for whom surgical treatment was indicated, kyphoplasty was found to be cost effective, and perhaps even cost saving, compared with vertebroplasty. Even for the oldest patients (85 years of age and older), both interventions would be considered cost effective in terms of cost per life-year gained.

  11. An Evaluation of Cost-Effectiveness of Micro Computerized ...

    African Journals Online (AJOL)

    /Integrated Set of Information System (CDS/ISIS) application software in the library and its effectiveness in performance operations was evaluated to determine the costeffectiveness. The study population was made up of all the staff involved ...

  12. Cost and cost-effectiveness of tuberculosis treatment shortening: a model-based analysis.

    Science.gov (United States)

    Gomez, G B; Dowdy, D W; Bastos, M L; Zwerling, A; Sweeney, S; Foster, N; Trajman, A; Islam, M A; Kapiga, S; Sinanovic, E; Knight, G M; White, R G; Wells, W A; Cobelens, F G; Vassall, A

    2016-12-01

    Despite improvements in treatment success rates for tuberculosis (TB), current six-month regimen duration remains a challenge for many National TB Programmes, health systems, and patients. There is increasing investment in the development of shortened regimens with a number of candidates in phase 3 trials. We developed an individual-based decision analytic model to assess the cost-effectiveness of a hypothetical four-month regimen for first-line treatment of TB, assuming non-inferiority to current regimens of six-month duration. The model was populated using extensive, empirically-collected data to estimate the economic impact on both health systems and patients of regimen shortening for first-line TB treatment in South Africa, Brazil, Bangladesh, and Tanzania. We explicitly considered 'real world' constraints such as sub-optimal guideline adherence. From a societal perspective, a shortened regimen, priced at USD1 per day, could be a cost-saving option in South Africa, Brazil, and Tanzania, but would not be cost-effective in Bangladesh when compared to one gross domestic product (GDP) per capita. Incorporating 'real world' constraints reduces cost-effectiveness. Patient-incurred costs could be reduced in all settings. From a health service perspective, increased drug costs need to be balanced against decreased delivery costs. The new regimen would remain a cost-effective option, when compared to each countries' GDP per capita, even if new drugs cost up to USD7.5 and USD53.8 per day in South Africa and Brazil; this threshold was above USD1 in Tanzania and under USD1 in Bangladesh. Reducing the duration of first-line TB treatment has the potential for substantial economic gains from a patient perspective. The potential economic gains for health services may also be important, but will be context-specific and dependent on the appropriate pricing of any new regimen.

  13. Cost-effectiveness of antenatal screening for neonatal alloimmune thrombocytopenia

    DEFF Research Database (Denmark)

    Killie, M K; Kjeldsen-Kragh, J; Husebekk, A

    2007-01-01

    OBJECTIVES: To estimate the costs and health consequences of three different screening strategies for neonatal alloimmune thrombocytopenia (NAIT). DESIGN: Cost-utility analysis on the basis of a decision tree that incorporates the relevant strategies and outcomes. SETTING: Three health regions......-4 weeks before term. Severely thrombocytopenic newborn were transfused immediately with compatible platelets. MAIN OUTCOME MEASUREMENTS: Quality-adjusted life years (QALYs) and costs. RESULTS: Compared with no screening, a programme of screening and subsequent treatment would generate between 210 and 230...... additional QALYs among 100,000 pregnant women, and at the same time, reduce health care costs by approximately 1.7 million euros. The sensitivity analyses indicate that screening is cost effective or even cost saving within a wide range of probabilities and costs. CONCLUSION: Our calculations indicate...

  14. Cost-effectiveness analysis of treatments for premenstrual dysphoric disorder.

    Science.gov (United States)

    Rendas-Baum, Regina; Yang, Min; Gricar, Joseph; Wallenstein, Gene V

    2010-01-01

    Premenstrual syndrome (PMS) is reported to affect between 13% and 31% of women. Between 3% and 8% of women are reported to meet criteria for the more severe form of PMS, premenstrual dysphoric disorder (PMDD). Although PMDD has received increased attention in recent years, the cost effectiveness of treatments for PMDD remains unknown. To evaluate the cost effectiveness of the four medications with a US FDA-approved indication for PMDD: fluoxetine, sertraline, paroxetine and drospirenone plus ethinyl estradiol (DRSP/EE). A decision-analytic model was used to evaluate both direct costs (medication and physician visits) and clinical outcomes (treatment success, failure and discontinuation). Medication costs were based on average wholesale prices of branded products; physician visit costs were obtained from a claims database study of PMDD patients and the Agency for Healthcare Research and Quality. Clinical outcome probabilities were derived from published clinical trials in PMDD. The incremental cost-effectiveness ratio (ICER) was calculated using the difference in costs and percentage of successfully treated patients at 6 months. Deterministic and probabilistic sensitivity analyses were used to assess the impact of uncertainty in parameter estimates. Threshold values where a change in the cost-effective strategy occurred were identified using a net benefit framework. Starting therapy with DRSP/EE dominated both sertraline and paroxetine, but not fluoxetine. The estimated ICER of initiating treatment with fluoxetine relative to DRSP/EE was $US4385 per treatment success (year 2007 values). Cost-effectiveness acceptability curves revealed that for ceiling ratios>or=$US3450 per treatment success, fluoxetine had the highest probability (>or=0.37) of being the most cost-effective treatment, relative to the other options. The cost-effectiveness acceptability frontier further indicated that DRSP/EE remained the option with the highest expected net monetary benefit for

  15. Cost effective nuclear commercial grade dedication

    International Nuclear Information System (INIS)

    Maletz, J.J.; Marston, M.J.

    1991-01-01

    This paper describes a new computerized database method to create/edit/view specification technical data sheets (mini-specifications) for procurement of spare parts for nuclear facility maintenance and to develop information that could support possible future facility life extension efforts. This method may reduce cost when compared with current manual methods. The use of standardized technical data sheets (mini-specifications) for items of the same category improves efficiency. This method can be used for a variety of tasks, including: Nuclear safety-related procurement; Non-safety related procurement; Commercial grade item procurement/dedication; Evaluation of replacement items. This program will assist the nuclear facility in upgrading its procurement activities consistent with the recent NUMARC Procurement Initiative. Proper utilization of the program will assist the user in assuring that the procured items are correct for the applications, provide data to assist in detecting fraudulent materials, minimize human error in withdrawing database information, improve data retrievability, improve traceability, and reduce long-term procurement costs

  16. Cost and Cost-Effectiveness of Donor Human Milk to Prevent Necrotizing Enterocolitis: Systematic Review.

    Science.gov (United States)

    Buckle, Abigail; Taylor, Celia

    2017-11-01

    Necrotizing enterocolitis (NEC) is a costly gastrointestinal disorder that mainly affects preterm and low-birth-weight infants and can lead to considerable morbidity and mortality. Mother's own milk is protective against NEC but is not always available. In such cases, donor human milk has also been shown to be protective (although to a lesser extent) compared with formula milk, but it is more expensive. This systematic review aimed at evaluating the cost of donor milk, the cost of treating NEC, and the cost-effectiveness of exclusive donor milk versus formula milk feeding to reduce the short-term health and treatment costs of NEC. We systematically searched five relevant databases to find studies with verifiable costs or charges of donor milk and/or treatment of NEC and any economic evaluations comparing exclusive donor milk with exclusive formula milk feeding. All search results were double screened. Seven studies with verifiable donor milk costs and 17 with verifiable NEC treatment costs were included. The types of cost or charge included varied considerably across studies, so quantitative synthesis was not attempted. Estimates of the incremental length of stay associated with NEC were ∼18 days for medical NEC and 50 days for surgical NEC. Two studies claimed to report economic evaluations but did not do so in practice. It is likely that donor milk provides short-term cost savings by reducing the incidence of NEC. Future studies should provide more details on cost components included and a full economic evaluation, including long-term outcomes, should be undertaken.

  17. A Systematic Review of Cost-Effectiveness Studies Reporting Cost-per-DALY Averted.

    Directory of Open Access Journals (Sweden)

    Peter J Neumann

    Full Text Available Calculating the cost per disability-adjusted life years (DALYs averted associated with interventions is an increasing popular means of assessing the cost-effectiveness of strategies to improve population health. However, there has been no systematic attempt to characterize the literature and its evolution.We conducted a systematic review of cost-effectiveness studies reporting cost-per-DALY averted from 2000 through 2015. We developed the Global Health Cost-Effectiveness Analysis (GHCEA Registry, a repository of English-language cost-per-DALY averted studies indexed in PubMed. To identify candidate studies, we searched PubMed for articles with titles or abstracts containing the phrases "disability-adjusted" or "DALY". Two reviewers with training in health economics independently reviewed each article selected in our abstract review, gathering information using a standardized data collection form. We summarized descriptive characteristics on study methodology: e.g., intervention type, country of study, study funder, study perspective, along with methodological and reporting practices over two time periods: 2000-2009 and 2010-2015. We analyzed the types of costs included in analyses, the study quality on a scale from 1 (low to 7 (high, and examined the correlation between diseases researched and the burden of disease in different world regions.We identified 479 cost-per-DALY averted studies published from 2000 through 2015. Studies from Sub-Saharan Africa comprised the largest portion of published studies. The disease areas most commonly studied were communicable, maternal, neonatal, and nutritional disorders (67%, followed by non-communicable diseases (28%. A high proportion of studies evaluated primary prevention strategies (59%. Pharmaceutical interventions were commonly assessed (32% followed by immunizations (28%. Adherence to good practices for conducting and reporting cost-effectiveness analysis varied considerably. Studies mainly included

  18. Psychophysiological effects of music on acute recovery from high-intensity interval training.

    Science.gov (United States)

    Jones, Leighton; Tiller, Nicholas B; Karageorghis, Costas I

    2017-03-01

    Numerous studies have examined the multifarious effects of music applied during exercise but few have assessed the efficacy of music as an aid to recovery. Music might facilitate physiological recovery via the entrainment of respiratory rhythms with music tempo. High-intensity exercise training is not typically associated with positive affective responses, and thus ways of assuaging negative affect warrant further exploration. This study assessed the psychophysiological effects of music on acute recovery and prevalence of entrainment in between bouts of high-intensity exercise. Thirteen male runners (M age =20.2±1.9years; BMI=21.7±1.7; V̇O 2 max=61.6±6.1mL·kg·min -1 ) completed three exercise sessions comprising 5×5-min bouts of high-intensity intervals interspersed with 3-min periods of passive recovery. During recovery, participants were administered positively-valenced music of a slow-tempo (55-65bpm), fast-tempo (125-135bpm), or a no-music control. A range of measures including affective responses, RPE, cardiorespiratory indices (gas exchange and pulmonary ventilation), and music tempo-respiratory entrainment were recorded during exercise and recovery. Fast-tempo, positively-valenced music resulted in higher Feeling Scale scores throughout recovery periods (pmusic-moderated differences in cardiorespiratory responses. In conclusion, fast-tempo, positively-valenced music applied during recovery periods engenders a more pleasant experience. However, there is limited evidence that music expedites cardiorespiratory recovery in between bouts of high-intensity exercise. These findings have implications for athletic training strategies and individuals seeking to make high-intensity exercise sessions more pleasant. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Implementation of self-rostering (the PRIO-project) Effects on working hours, recovery and health

    DEFF Research Database (Denmark)

    Garde, Anne Helene; Albertsen, Karen; Nabe Nielsen, Kirsten

    2012-01-01

    Objectives The aim of this study was to (i) investigate the consequences of self-rostering for working hours, recovery, and health, and (ii) elucidate the mechanisms through which recovery and health are affected. Methods Twenty eight workplaces were allocated to either an intervention or reference...... workplace reports of working hours (N=718) were obtained at baseline and 12 months later. The interaction term between intervention and time was tested in mixed models and multinomial logistic regression models. Results The odds ratio (OR) of having short [OR 4.8, 95 % confidence interval (95% CI) 1.......17, 95% CI -0.29– -0.04) and B (β= -0.17, 95% CI -0.27– -0.07). There were no effects on recovery and health in intervention C, and overall, there were no detrimental effects on recovery or health. The benefits of the intervention were not related to changes in working hours and did not differ by gender...

  20. LCA and Cost Analysis of Membrane Bioreactor Systems: Influence of Scale, Population Density, Climate, and Methane Recovery

    Science.gov (United States)

    Future changes in drinking and waste water infrastructure need to incorporate a holistic view of the water service sustainability tradeoffs and potential benefits when considering shifts towards new treatment technology, decentralized systems, energy recovery and reuse of treated...

  1. Cost-effectiveness of emergency contraception options over 1 year.

    Science.gov (United States)

    Bellows, Brandon K; Tak, Casey R; Sanders, Jessica N; Turok, David K; Schwarz, Eleanor B

    2018-05-01

    The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. We sought to compare the cost-effectiveness of 4 emergency contraception strategies-ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device-over 1 year from a US payer perspective. Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. In 1000 women

  2. Effects of cold water immersion and active recovery on hemodynamics and recovery of muscle strength following resistance exercise.

    Science.gov (United States)

    Roberts, Llion A; Muthalib, Makii; Stanley, Jamie; Lichtwark, Glen; Nosaka, Kazunori; Coombes, Jeff S; Peake, Jonathan M

    2015-08-15

    Cold water immersion (CWI) and active recovery (ACT) are frequently used as postexercise recovery strategies. However, the physiological effects of CWI and ACT after resistance exercise are not well characterized. We examined the effects of CWI and ACT on cardiac output (Q̇), muscle oxygenation (SmO2), blood volume (tHb), muscle temperature (Tmuscle), and isometric strength after resistance exercise. On separate days, 10 men performed resistance exercise, followed by 10 min CWI at 10°C or 10 min ACT (low-intensity cycling). Q̇ (7.9 ± 2.7 l) and Tmuscle (2.2 ± 0.8°C) increased, whereas SmO2 (-21.5 ± 8.8%) and tHb (-10.1 ± 7.7 μM) decreased after exercise (P < 0.05). During CWI, Q̇ (-1.1 ± 0.7 l) and Tmuscle (-6.6 ± 5.3°C) decreased, while tHb (121 ± 77 μM) increased (P < 0.05). In the hour after CWI, Q̇ and Tmuscle remained low, while tHb also decreased (P < 0.05). By contrast, during ACT, Q̇ (3.9 ± 2.3 l), Tmuscle (2.2 ± 0.5°C), SmO2 (17.1 ± 5.7%), and tHb (91 ± 66 μM) all increased (P < 0.05). In the hour after ACT, Tmuscle, and tHb remained high (P < 0.05). Peak isometric strength during 10-s maximum voluntary contractions (MVCs) did not change significantly after CWI, whereas it decreased after ACT (-30 to -45 Nm; P < 0.05). Muscle deoxygenation time during MVCs increased after ACT (P < 0.05), but not after CWI. Muscle reoxygenation time after MVCs tended to increase after CWI (P = 0.052). These findings suggest first that hemodynamics and muscle temperature after resistance exercise are dependent on ambient temperature and metabolic demands with skeletal muscle, and second, that recovery of strength after resistance exercise is independent of changes in hemodynamics and muscle temperature. Copyright © 2015 the American Physiological Society.

  3. Effect of whey protein hydrolysate on performance and recovery of top-class orienteering runners

    DEFF Research Database (Denmark)

    Hansen, Mette; Bangsbo, Jens; Jensen, Jørgen

    2015-01-01

    This trial aimed to examine the effect of whey protein hydrolysate intake before and after exercise sessions on endurance performance and recovery in elite orienteers during a training camp. Eighteen elite orienteers participated in a randomized controlled intervention trial during a 1-week...... a strenuous 1-week training camp. The results indicate that protein supplementation in conjunction with each exercise session facilitates the recovery from strenuous training in elite orienteers....

  4. The effect of local cryotherapy on subjective and objective recovery characteristics following an exhaustive jump protocol.

    Science.gov (United States)

    Hohenauer, Erich; Clarys, Peter; Baeyens, Jean-Pierre; Clijsen, Ron

    2016-01-01

    The purpose of this controlled trial was to investigate the effects of a single local cryotherapy session on the recovery characteristics over a period of 72 hours. Twenty-two young and healthy female (n=17; mean age: 21.9±1.1 years) and male (n=5;mean age: 25.4±2.8 years) adults participated in this study. Following an exhaustive jump protocol (3×30 countermovement jumps), half of the participants received either a single local cryotherapy application (+8°C) or a single local thermoneutral application (+32°C) of 20-minute duration using two thigh cuffs. Subjective measures of recovery (delayed-onset muscle soreness and ratings of perceived exertion) and objective measures of recovery (vertical jump performance and peak power output) were assessed immediately following the postexercise applications (0 hours) and at 24 hours, 48 hours, and 72 hours after the jump protocol. Local cryotherapy failed to significantly affect any subjective recovery variable during the 72-hour recovery period (P>0.05). After 72 hours, the ratings of perceived exertion were significantly lower in the thermoneutral group compared to that in the cryotherapy group (P=0.002). No significant differences were observed between the cryotherapy and the thermoneutral groups with respect to any of the objective recovery variables. In this experimental study, a 20-minute cryotherapy cuff application failed to demonstrate a positive effect on any objective measures of recovery. The effects of local thermoneutral application on subjective recovery characteristics were superior when compared to the effects of local cryotherapy application at 72 hours postapplication.

  5. The effects of job satisfaction, employee commitment, workplace friendship and team culture on service recovery performance

    OpenAIRE

    Abednego Feehi Okoe; Henry Boateng; Tiniwah Deborah Mensah

    2016-01-01

    The existing literature has called for more studies to be conducted on how human resource activities affect service recovery performance. This study therefore ascertains the effects of Job Satisfaction, employee Commitment, Workplace Friendship and Team Culture on Service Recovery Performance. The survey research design was used in this study. The participants were frontline employees from the various service sectors in Ghana. The convenience sampling was used as the sampling technique. A tot...

  6. Occupational Stress and Mental Health Symptoms: Examining the Moderating Effect of Work Recovery Strategies in Firefighters.

    Science.gov (United States)

    Sawhney, Gargi; Jennings, Kristen S; Britt, Thomas W; Sliter, Michael T

    2017-06-12

    The goal of this research was to examine the moderating effect of work recovery strategies on the relationship between occupational stress experienced by firefighters and mental health symptoms. Work recovery strategies were identified through semistructured interviews with 20 firefighters and a literature search on recovery strategies. A total of 7 work recovery strategies emerged using the 2 methods: work-related talks, stress-related talks, time with coworkers/supervisor, exercise, recreational activities, relaxation, and mastery experiences. Using a prospective study design with a 1-month time interval in a sample of 268 firefighters, experienced occupational stress at Time 1 was positively related to mental health symptoms at Time 2. In addition, with the exception of spending time with coworkers/supervisor, exercise and mastery experiences, recovery strategies at Time 1 were negatively related to mental health symptoms at Time 2. Lastly, all work recovery strategies, except stress-related talks and relaxation, moderated the relationship between experienced occupational stress at Time 1 and mental health symptoms at Time 2. Specifically, the positive relationship between experienced occupational stress and mental health symptoms was stronger when firefighters engaged in low, rather than high, work recovery strategies. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  7. Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

    Directory of Open Access Journals (Sweden)

    Vos Theo

    2011-05-01

    Full Text Available Abstract Background Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. Methods A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Results Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention. Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. Conclusions There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates

  8. Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia.

    Science.gov (United States)

    Phanthunane, Pudtan; Vos, Theo; Whiteford, Harvey; Bertram, Melanie

    2011-05-13

    Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine may be dominated and there are serious

  9. Cost-effectiveness of pharmacological and psychosocial interventions for schizophrenia

    Science.gov (United States)

    2011-01-01

    Background Information on cost-effectiveness of interventions to treat schizophrenia can assist health policy decision making, particularly given the lack of health resources in developing countries like Thailand. This study aims to determine the optimal treatment package, including drug and non-drug interventions, for schizophrenia in Thailand. Methods A Markov model was used to evaluate the cost-effectiveness of typical antipsychotics, generic risperidone, olanzapine, clozapine and family interventions. Health outcomes were measured in disability adjusted life years. We evaluated intervention benefit by estimating a change in disease severity, taking into account potential side effects. Intervention costs included outpatient treatment costs, hospitalization costs as well as time and travel costs of patients and families. Uncertainty was evaluated using Monte Carlo simulation. A sensitivity analysis of the expected range cost of generic risperidone was undertaken. Results Generic risperidone is more cost-effective than typicals if it can be produced for less than 10 baht per 2 mg tablet. Risperidone was the cheapest treatment with higher drug costs offset by lower hospital costs in comparison to typicals. The most cost-effective combination of treatments was a combination of risperidone (dominant intervention). Adding family intervention has an incremental cost-effectiveness ratio of 1,900 baht/DALY with a 100% probability of a result less than a threshold for very cost-effective interventions of one times GDP or 110,000 baht per DALY. Treating the most severe one third of patients with clozapine instead of risperidone had an incremental cost-effectiveness ratio of 320,000 baht/DALY with just over 50% probability of a result below three times GDP per capita. Conclusions There are good economic arguments to recommend generic risperidone as first line treatment in combination with family intervention. As the uncertainty interval indicates the addition of clozapine

  10. Cost-effectiveness of root caries preventive treatments.

    Science.gov (United States)

    Schwendicke, Falk; Göstemeyer, Gerd

    2017-01-01

    With a growing number of individuals retaining their teeth lifelong, often with periodontitis-induced root surface exposure, there is the need for cost-effective management strategies for root caries lesions. The present study aimed to assess the cost-effectiveness of root caries preventive treatments. Patients were simulated over 10 years using a Markov model. Four treatments were compared: No treatment, daily 225-800ppm fluoride rinses, chlorhexidine (CHX) varnish (2×/year), silver diamine fluoride (SDF) varnish (2×/year). Data from a systematic review were submitted to network meta-analysis for inferring relative efficacies of treatments. The health outcome was years of teeth being free of root caries. A mixed public-private payer perspective within 2016 German healthcare was taken, with costs being estimated from fee item catalogues or based on market prices. Populations with different numbers of teeth and tooth-level risks were modelled. Monte-Carlo microsimulations, univariate- and probabilistic sensitivity analyses were performed. In populations with 16 teeth at risk and low tooth-level risk for root caries, providing no preventive treatment was least costly, but also least effective (130 Euro, 144 years). SDF ranked next, being more costly (180 Euro), but also more effective (151 years). Payers willing to invest 8.30 Euro per root caries-free tooth-year found SDF most cost-effective. CHX varnish and fluoride rinse were not cost-effective. In populations with more teeth and high tooth-level risk, SDF was the most effective and least costly option. Root caries preventive treatments (like SDF) are effective and might even be cost-saving in high risk populations. Application of SDF can be recommended as a cost-saving treatment for prevention of root caries in patients with high risk of root caries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Is individualized medicine more cost-effective? A systematic review.

    Science.gov (United States)

    Hatz, Maximilian H M; Schremser, Katharina; Rogowski, Wolf H

    2014-05-01

    Individualized medicine (IM) is a rapidly evolving field that is associated with both visions of more effective care at lower costs and fears of highly priced, low-value interventions. It is unclear which view is supported by the current evidence. Our objective was to systematically review the health economic evidence related to IM and to derive general statements on its cost-effectiveness. A literature search of MEDLINE database for English- and German-language studies was conducted. Cost-effectiveness and cost-utility studies for technologies meeting the MEDLINE medical subject headings (MeSH) definition of IM (genetically targeted interventions) were reviewed. This was followed by a standardized extraction of general study characteristics and cost-effectiveness results. Most of the 84 studies included in the synthesis were from the USA (n = 43, 51 %), cost-utility studies (n = 66, 79 %), and published since 2005 (n = 60, 71 %). The results ranged from dominant to dominated. The median value (cost-utility studies) was calculated to be rounded $US22,000 per quality-adjusted life year (QALY) gained (adjusted to $US, year 2008 values), which is equal to the rounded median cost-effectiveness in the peer-reviewed English-language literature according to a recent review. Many studies reported more than one strategy of IM with highly varying cost-effectiveness ratios. Generally, results differed according to test type, and tests for disease prognosis or screening appeared to be more favorable than tests to stratify patients by response or by risk of adverse effects. However, these results were not significant. Different definitions of IM could have been used. Quality assessment of the studies was restricted to analyzing transparency. IM neither seems to display superior cost-effectiveness than other types of medical interventions nor to be economically inferior. Instead, rather than 'whether' healthcare was individualized, the question of 'how' it was individualized was

  12. Structuring a cost-effective site characterization

    International Nuclear Information System (INIS)

    Berven, B.A.; Little, C.A.; Swaja, R.E.

    1990-01-01

    Successful chemical and radiological site characterizations are complex activities which require meticulously detailed planning. Each layer of investigation is based upon previously generated information about the site. Baseline historical, physical, geological, and regulatory information is prerequisite for preliminary studies at a site. Preliminary studies then provide samples and measurements which define the identity of potential contaminants and define boundaries around the area to be investigated. The goal of a full site characterization is to accurately determine the extent and magnitude of contaminants and carefully define the site conditions such that the future movements of site contaminants can be assessed for potential exposure to human occupants and/or environmental impacts. Critical to this process is the selection of appropriate measurement and sampling methodology, selection and use of appropriate instrumentation and management/interpretation of site information. Site investigations require optimization between the need of information to maximize the understanding of site conditions and the cost of acquiring that information. 5 refs., 1 tab

  13. Proposals for software analysis of cost effectiveness and cost-benefit for optimisation of radiation protection

    International Nuclear Information System (INIS)

    Schieber, C.; Lombard, J.; Lefaure, C.

    1990-06-01

    The objective of this report is to present the principles of decision making software for radiation protection option, applying ALARA principle. The choice of optimum options is performed by applying the models of cost effectiveness and cost-benefit. Options of radiation protection are described by two indicators: a simple economic indicator: cost of radiation protection; and dosimetry indicator: collective dose related to protection. For both analyses the software enables sensitivity analysis. It would be possible to complete the software by integrating a module which would take into account combinations of two options since they are not independent

  14. Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer.

    Science.gov (United States)

    Goldstein, Daniel A; Ahmad, Bilal B; Chen, Qiushi; Ayer, Turgay; Howard, David H; Lipscomb, Joseph; El-Rayes, Bassel F; Flowers, Christopher R

    2015-11-10

    Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing. © 2015 by American Society of Clinical Oncology.

  15. How does cognitive dissonance influence the sunk cost effect?

    Directory of Open Access Journals (Sweden)

    Chung SH

    2018-03-01

    Full Text Available Shao-Hsi Chung,1 Kuo-Chih Cheng2 1Department of Business Administration, Meiho University, Pingtung, Taiwan; 2Department of Accounting, National Changhua University of Education, Changhua City, Taiwan Background: The sunk cost effect is the scenario when individuals are willing to continue to invest capital in a failing project. The purpose of this study was to explain such irrational behavior by exploring how sunk costs affect individuals’ willingness to continue investing in an unfavorable project and to understand the role of cognitive dissonance on the sunk cost effect. Methods: This study used an experimental questionnaire survey on managers of firms listed on the Taiwan Stock Exchange and Over-The-Counter. Results: The empirical results show that cognitive dissonance does not mediate the relationship between sunk costs and willingness to continue an unfavorable investment project. However, cognitive dissonance has a moderating effect, and only when the level of cognitive dissonance is high does the sunk cost have significantly positive impacts on willingness to continue on with an unfavorable investment. Conclusion: This study offers psychological mechanisms to explain the sunk cost effect based on the theory of cognitive dissonance, and it also provides some recommendations for corporate management. Keywords: sunk costs, sunk cost effect, cognitive dissonance, behavior, unfavorable investment

  16. The Role of Dairy in Effectiveness and Cost of Treatment of Children With Moderate Acute Malnutrition: A Narrative Review.

    Science.gov (United States)

    Suri, Devika J; Moorthy, Denish; Rosenberg, Irwin H

    2016-06-01

    Dairy is recommended in specially formulated supplementary foods to treat children with moderate acute malnutrition (MAM) but with limited evidence and added cost. Review studies of ready-to-use foods (RUFs) versus fortified blended foods (FBFs) to determine whether inclusion of dairy modifies the comparative effectiveness and cost. We reviewed literature comparing FBF and RUF in treatment of MAM among children younger than 5 years in developing countries. Outcomes of recovery from MAM, weight, and length gain were compared among treatment categories: FBF with dairy (FBF+), FBF without dairy (FBF-), RUF with dairy (RUF+), and RUF without dairy (RUF-). Supplement cost was compared per 500 kcal. Eight studies were included. Rations were heterogeneous in energy and type of dairy. Overall, RUF+, RUF-, and FBF+ performed similarly, with higher recovery and weight gain compared with FBF-. RUF+ had higher recovery (in 5 of 6 comparisons), weight gain (4 of 4), and length gain (1 of 4) versus FBF-. The RUF+ had higher recovery (1 of 2) versus FBF+, with no other differences. The RUF- versus FBF+ had no differences (0 of 2). The RUF- had higher recovery (1 of 2), weight gain (2 of 2) versus FBF-. Four studies reported supplement costs, which averaged US$0.15 (FBF-), US$0.18 (FBF+), US$0.18 (RUF-), and US$0.37 (RUF+) per 500 kcal. There is a consistent benefit of FBF that include dairy in treatment of children with MAM. Benefits of dairy in RUF require further investigation. Evidence from rigorous quantitative analysis of existing data, cost-effectiveness, and prospective trials will be essential in determining policy on treatment for children with MAM. © The Author(s) 2016.

  17. Modelling the cost effectiveness of antidepressant treatment in primary care.

    Science.gov (United States)

    Revicki, D A; Brown, R E; Palmer, W; Bakish, D; Rosser, W W; Anton, S F; Feeny, D

    1995-12-01

    The aim of this study was to estimate the cost effectiveness of nefazodone compared with imipramine or fluoxetine in treating women with major depressive disorder. Clinical decision analysis and a Markov state-transition model were used to estimate the lifetime health outcomes and medical costs of 3 antidepressant treatments. The model, which represents ideal primary care practice, compares treatment with nefazodone to treatment with either imipramine or fluoxetine. The economic analysis was based on the healthcare system of the Canadian province of Ontario, and considered only direct medical costs. Health outcomes were expressed as quality-adjusted life years (QALYs) and costs were in 1993 Canadian dollars ($Can; $Can1 = $US0.75, September 1995). Incremental cost-utility ratios were calculated comparing the relative lifetime discounted medical costs and QALYs associated with nefazodone with those of imipramine or fluoxetine. Data for constructing the model and estimating necessary parameters were derived from the medical literature, clinical trial data, and physician judgement. Data included information on: Ontario primary care physicians' clinical management of major depression; medical resource use and costs; probabilities of recurrence of depression; suicide rates; compliance rates; and health utilities. Estimates of utilities for depression-related hypothetical health states were obtained from patients with major depression (n = 70). Medical costs and QALYs were discounted to present value using a 5% rate. Sensitivity analyses tested the assumptions of the model by varying the discount rate, depression recurrence rates, compliance rates, and the duration of the model. The base case analysis found that nefazodone treatment costs $Can1447 less per patient than imipramine treatment (discounted lifetime medical costs were $Can50,664 vs $Can52,111) and increases the number of QALYs by 0.72 (13.90 vs 13.18). Nefazodone treatment costs $Can14 less than fluoxetine

  18. Encouraging smokers to quit: the cost effectiveness of reimbursing the costs of smoking cessation treatment.

    Science.gov (United States)

    Kaper, Janneke; Wagena, Edwin J; van Schayck, Constant P; Severens, Johan L

    2006-01-01

    Smoking cessation should be encouraged in order to increase life expectancy and reduce smoking-related healthcare costs. Results of a randomised trial suggested that reimbursing the costs of smoking cessation treatment (SCT) may lead to an increased use of SCT and an increased number of quitters versus no reimbursement. To assess whether reimbursement for SCT is a cost-effective intervention (from the Dutch societal perspective), we calculated the incremental costs per quitter and extrapolated this outcome to incremental costs per QALY saved versus no reimbursement. In the reimbursement trial, 1266 Dutch smokers were randomly assigned to the intervention or control group using a randomised double consent design. Reimbursement for SCT was offered to the intervention group for a period of 6 months. No reimbursement was offered to the control group. Prolonged abstinence from smoking was determined 6 months after the end of the reimbursement period. The QALYs gained from quitting were calculated until 80 years of age using data from the US. Costs (year 2002 values) were determined from the societal perspective during the reimbursement period (May-November 2002). Benefits were discounted at 4% per annum. The uncertainty of the incremental cost-effectiveness ratios was estimated using non-parametric bootstrapping. Eighteen participants in the control group (2.8%) and 35 participants in the intervention group (5.5%) successfully quit smoking. The costs per participant were 291 euro and 322 euro, respectively. If society is willing to pay 1000 euro or 10,000 euro for an additional 12-month quitter, the probability that reimbursement for SCT would be cost effective was 50% or 95%, respectively. If society is willing to pay 18,000 euro for a QALY, the probability that reimbursement for SCT would be cost effective was 95%. However, the external validity of the extrapolation from quitters to QALYs is uncertain and several assumptions had to be made. Reimbursement for SCT may

  19. Cost-effective conservation of an endangered frog under uncertainty.

    Science.gov (United States)

    Rose, Lucy E; Heard, Geoffrey W; Chee, Yung En; Wintle, Brendan A

    2016-04-01

    How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective

  20. Skeletal traction and intramedullary nailing cost-effectiveness

    African Journals Online (AJOL)

    In the operative group 24 patients had union with one delayed union while in the traction group 12 patients had union, 9 with mal union and 4 delayed union. Conclusion: Intramedullary nailing is more cost-effective than skeletal traction. It met the dominant strategy, because it was significantly less costly than skeletal ...

  1. Pressure relieving support surfaces (PRESSURE) trial: cost effectiveness analysis.

    Science.gov (United States)

    Iglesias, Cynthia; Nixon, Jane; Cranny, Gillian; Nelson, E Andrea; Hawkins, Kim; Phillips, Angela; Torgerson, David; Mason, Su; Cullum, Nicky

    2006-06-17

    To assess the cost effectiveness of alternating pressure mattresses compared with alternating pressure overlays for the prevention of pressure ulcers in patients admitted to hospital. Cost effectiveness analysis carried out alongside the pressure relieving support surfaces (PRESSURE) trial; a multicentre UK based pragmatic randomised controlled trial. 11 hospitals in six UK NHS trusts. Intention to treat population comprising 1971 participants. Kaplan Meier estimates of restricted mean time to development of pressure ulcers and total costs for treatment in hospital. Alternating pressure mattresses were associated with lower overall costs (283.6 pounds sterling per patient on average, 95% confidence interval--377.59 pounds sterling to 976.79 pounds sterling) mainly due to reduced length of stay in hospital, and greater benefits (a delay in time to ulceration of 10.64 days on average,--24.40 to 3.09). The differences in health benefits and total costs for hospital stay between alternating pressure mattresses and alternating pressure overlays were not statistically significant; however, a cost effectiveness acceptability curve indicated that on average alternating pressure mattresses compared with alternating pressure overlays were associated with an 80% probability of being cost saving. Alternating pressure mattresses for the prevention of pressure ulcers are more likely to be cost effective and are more acceptable to patients than alternating pressure overlays.

  2. Improving cost-effectiveness of hypertension management at a ...

    African Journals Online (AJOL)

    Objectives. To describe the pattern of prescribing for hypertension at a community health centre (CHC) and to evaluate the impact of introducing treatment guidelines and restricting availability of less cost-effective antihypertensive drugs on prescribing patterns, costs of drug treatment and blood pressure (BP) control. Design ...

  3. Flipping the Calculus Classroom: A Cost-Effective Approach

    Science.gov (United States)

    Young, Andrea

    2015-01-01

    This article discusses a cost-effective approach to flipping the calculus classroom. In particular, the emphasis is on low-cost choices, both monetarily and with regards to faculty time, that make the daunting task of flipping a course manageable for a single instructor. Student feedback and overall impressions are also presented.

  4. Cost effectiveness of detritiating water with resin columns

    International Nuclear Information System (INIS)

    Drake, R.H.; Williams, D.S.

    1997-10-01

    There are technologies in use for cleaning up concentrated tritiated process water. These are not cost effective for tritiated water with low concentrations of tritium. There are currently no cost-effective technologies for cleaning up low-tritium-concentration tritiated water, such as most tritiated groundwater, spent fuel storage basin water, or underground storage tank water. Resin removal of tritium from tritiated water at low concentrations (near the order of magnitude of drinking water standard maximums) is being tested on TA-SO (Los Alamos National Laboratory's Liquid Radioactive Waste Treatment Facility) waste streams. There are good theoretical and test indications that this may be a technologically effective means of removing tritium from tritiated water. Because of likely engineering design similarity, it is reasonable to anticipate that a resin column system's costs will be similar to some common commercial water treatment systems. Thus, the potential cost effectiveness of a resin treatment system offers hope for treating tritiated water at affordable costs. The TA-50 resin treatment cost projection of $18 per 1,000 gallons is within the same order of magnitude as cost data for typical commercial groundwater cleanup projects. The prospective Los Alamos National Laboratory (LANL) resin treatment system at $18 per 1,000 gallons appears to have a likely cost advantage of at least an order of magnitude over the competing, developmental, water detritiation technologies

  5. The Effectiveness of Low-Cost Tele-Lecturing.

    Science.gov (United States)

    Muta, Hiromitsu; Kikuta, Reiko; Hamano, Takashi; Maesako, Takanori

    1997-01-01

    Compares distance education using PictureTel, a compressed-digital-video system via telephone lines (audio and visual interactive communication) in terms of its costs and effectiveness with traditional in-class education. Costing less than half the traditional approach, the study suggested distance education would be economical if used frequently.…

  6. Discriminant Analysis of the Effects of Software Cost Drivers on ...

    African Journals Online (AJOL)

    The paper work investigates the effect of software cost drivers on project schedule estimation of software development projects in Nigeria. Specifically, the paper determines the extent to which software cost variables affect our software project time schedule in our environment. Such studies are lacking in the recent ...

  7. Systemic cost-effectiveness analysis of food hazard reduction

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Lawson, Lartey Godwin; Lund, Mogens

    2015-01-01

    stage are considered. Cost analyses are conducted for different risk reduction targets and for three alternative scenarios concerning the acceptable range of interventions. Results demonstrate that using a system-wide policy approach to risk reduction can be more cost-effective than a policy focusing...

  8. Welfare effects of the internalization of external cost

    International Nuclear Information System (INIS)

    Lijesen, M.; Korteweg, J.A.; Derriks, H.

    2009-03-01

    The effect of passing through the cost of external effects such as accidents, environment and noise to traffic and transport have been mapped. In nine out of the ten examined variants this 'internalization' will lead to an increase in welfare in the Netherlands. Internalization leads to a decrease of external costs of over 100 million to more than 1.7 billion euros annually. Internalization also brings about collection costs, international transfers and logistic adjustments. The balance of these effects varies from a welfare loss of 20 million euros to a welfare increase of 1.2 billion euros annually. [nl

  9. Operating dedicated data centers – is it cost-effective?

    International Nuclear Information System (INIS)

    Ernst, M; Hogue, R; Hollowell, C; Strecker-Kellog, W; Wong, A; Zaytsev, A

    2014-01-01

    The advent of cloud computing centres such as Amazon's EC2 and Google's Computing Engine has elicited comparisons with dedicated computing clusters. Discussions on appropriate usage of cloud resources (both academic and commercial) and costs have ensued. This presentation discusses a detailed analysis of the costs of operating and maintaining the RACF (RHIC and ATLAS Computing Facility) compute cluster at Brookhaven National Lab and compares them with the cost of cloud computing resources under various usage scenarios. An extrapolation of likely future cost effectiveness of dedicated computing resources is also presented.

  10. Operating Dedicated Data Centers - Is It Cost-Effective?

    Science.gov (United States)

    Ernst, M.; Hogue, R.; Hollowell, C.; Strecker-Kellog, W.; Wong, A.; Zaytsev, A.

    2014-06-01

    The advent of cloud computing centres such as Amazon's EC2 and Google's Computing Engine has elicited comparisons with dedicated computing clusters. Discussions on appropriate usage of cloud resources (both academic and commercial) and costs have ensued. This presentation discusses a detailed analysis of the costs of operating and maintaining the RACF (RHIC and ATLAS Computing Facility) compute cluster at Brookhaven National Lab and compares them with the cost of cloud computing resources under various usage scenarios. An extrapolation of likely future cost effectiveness of dedicated computing resources is also presented.

  11. Planning tiger recovery: Understanding intraspecific variation for effective conservation

    Science.gov (United States)

    Wilting, Andreas; Courtiol, Alexandre; Christiansen, Per; Niedballa, Jürgen; Scharf, Anne K.; Orlando, Ludovic; Balkenhol, Niko; Hofer, Heribert; Kramer-Schadt, Stephanie; Fickel, Jörns; Kitchener, Andrew C.

    2015-01-01

    Although significantly more money is spent on the conservation of tigers than on any other threatened species, today only 3200 to 3600 tigers roam the forests of Asia, occupying only 7% of their historical range. Despite the global significance of and interest in tiger conservation, global approaches to plan tiger recovery are partly impeded by the lack of a consensus on the number of tiger subspecies or management units, because a comprehensive analysis of tiger variation is lacking. We analyzed variation among all nine putative tiger subspecies, using extensive data sets of several traits [morphological (craniodental and pelage), ecological, molecular]. Our analyses revealed little variation and large overlaps in each trait among putative subspecies, and molecular data showed extremely low diversity because of a severe Late Pleistocene population decline. Our results support recognition of only two subspecies: the Sunda tiger, Panthera tigris sondaica, and the continental tiger, Panthera tigris tigris, which consists of two (northern and southern) management units. Conservation management programs, such as captive breeding, reintroduction initiatives, or trans-boundary projects, rely on a durable, consistent characterization of subspecies as taxonomic units, defined by robust multiple lines of scientific evidence rather than single traits or ad hoc descriptions of one or few specimens. Our multiple-trait data set supports a fundamental rethinking of the conventional tiger taxonomy paradigm, which will have profound implications for the management of in situ and ex situ tiger populations and boost conservation efforts by facilitating a pragmatic approach to tiger conservation management worldwide. PMID:26601191

  12. Planning tiger recovery: Understanding intraspecific variation for effective conservation.

    Science.gov (United States)

    Wilting, Andreas; Courtiol, Alexandre; Christiansen, Per; Niedballa, Jürgen; Scharf, Anne K; Orlando, Ludovic; Balkenhol, Niko; Hofer, Heribert; Kramer-Schadt, Stephanie; Fickel, Jörns; Kitchener, Andrew C

    2015-06-01

    Although significantly more money is spent on the conservation of tigers than on any other threatened species, today only 3200 to 3600 tigers roam the forests of Asia, occupying only 7% of their historical range. Despite the global significance of and interest in tiger conservation, global approaches to plan tiger recovery are partly impeded by the lack of a consensus on the number of tiger subspecies or management units, because a comprehensive analysis of tiger variation is lacking. We analyzed variation among all nine putative tiger subspecies, using extensive data sets of several traits [morphological (craniodental and pelage), ecological, molecular]. Our analyses revealed little variation and large overlaps in each trait among putative subspecies, and molecular data showed extremely low diversity because of a severe Late Pleistocene population decline. Our results support recognition of only two subspecies: the Sunda tiger, Panthera tigris sondaica, and the continental tiger, Panthera tigris tigris, which consists of two (northern and southern) management units. Conservation management programs, such as captive breeding, reintroduction initiatives, or trans-boundary projects, rely on a durable, consistent characterization of subspecies as taxonomic units, defined by robust multiple lines of scientific evidence rather than single traits or ad hoc descriptions of one or few specimens. Our multiple-trait data set supports a fundamental rethinking of the conventional tiger taxonomy paradigm, which will have profound implications for the management of in situ and ex situ tiger populations and boost conservation efforts by facilitating a pragmatic approach to tiger conservation management worldwide.

  13. Wood pellets. The cost-effective fuel

    International Nuclear Information System (INIS)

    Anon.

    2001-01-01

    The article is based on an interview with Juhani Hakkarainen of Vapo Oy. Wood pellets are used in Finland primarily to heat buildings such as schools and offices and in the home. They are equally suitable for use in larger installations such as district heating plants and power stations. According to him wood pellets are suitable for use in coal-fired units generating heat, power, and steam. Price-wise, wood pellets are a particularly competitive alternative for small coal-fired plants away from the coast. Price is not the only factor on their side, however. Wood pellets also offer a good environmental profile, as they burn cleanly and generate virtually no dust, an important plus in urban locations. The fact that pellets are a domestically produced fuel is an added benefit, as their price does not fluctuate in the same way that the prices of electricity, oil, coal, and natural gas do. The price of pellets is largely based on direct raw material and labour costs, which are much less subject to ups and downs

  14. Effects of introducing energy recovery processes to the municipal solid waste management system in Ulaanbaatar, Mongolia.

    Science.gov (United States)

    Toshiki, Kosuke; Giang, Pham Quy; Serrona, Kevin Roy B; Sekikawa, Takahiro; Yu, Jeoung-soo; Choijil, Baasandash; Kunikane, Shoichi

    2015-02-01

    Currently, most developing countries have not set up municipal solid waste management systems with a view of recovering energy from waste or reducing greenhouse gas emissions. In this article, we have studied the possible effects of introducing three energy recovery processes either as a single or combination approach, refuse derived fuel production, incineration and waste power generation, and methane gas recovery from landfill and power generation in Ulaanbaatar, Mongolia, as a case study. We concluded that incineration process is the most suitable as first introduction of energy recovery. To operate it efficiently, 3Rs strategies need to be promoted. And then, RDF production which is made of waste papers and plastics in high level of sorting may be considered as the second step of energy recovery. However, safety control and marketability of RDF will be required at that moment. Copyright © 2014. Published by Elsevier B.V.

  15. Recovery Based Nanowire Field-Effect Transistor Detection of Pathogenic Avian Influenza DNA

    Science.gov (United States)

    Lin, Chih-Heng; Chu, Chia-Jung; Teng, Kang-Ning; Su, Yi-Jr; Chen, Chii-Dong; Tsai, Li-Chu; Yang, Yuh-Shyong

    2012-02-01

    Fast and accurate diagnosis is critical in infectious disease surveillance and management. We proposed a DNA recovery system that can easily be adapted to DNA chip or DNA biosensor for fast identification and confirmation of target DNA. This method was based on the re-hybridization of DNA target with a recovery DNA to free the DNA probe. Functionalized silicon nanowire field-effect transistor (SiNW FET) was demonstrated to monitor such specific DNA-DNA interaction using high pathogenic strain virus hemagglutinin 1 (H1) DNA of avian influenza (AI) as target. Specific electric changes were observed in real-time for AI virus DNA sensing and device recovery when nanowire surface of SiNW FET was modified with complementary captured DNA probe. The recovery based SiNW FET biosensor can be further developed for fast identification and further confirmation of a variety of influenza virus strains and other infectious diseases.

  16. Medicaid program; premiums and cost sharing. Final rule; delay of effective date and reopening of comment period.

    Science.gov (United States)

    2009-03-27

    This action temporarily delays the effective date of the November 25, 2008 final rule entitled, Medicaid Program; Premiums and Cost Sharing" (73 FR 71828) until December 31, 2009. In addition, this action reopens the comment period on the policies set out in the November 25, 2008 final rule, and specifically solicits comments on the effect of certain provisions of the American Recovery and Reinvestment Act of 2009.

  17. Lifecycle effects of a recession on health behaviors: Boom, bust, and recovery in Iceland.

    Science.gov (United States)

    Ásgeirsdóttir, Tinna Laufey; Corman, Hope; Noonan, Kelly; Reichman, Nancy E

    2016-03-01

    This study uses individual-level longitudinal data from Iceland, a country that experienced a severe economic crisis in 2008 and substantial recovery by 2012, to investigate the extent to which the effects of a recession on health behaviors are lingering or short-lived and to explore trajectories in health behaviors from pre-crisis boom, to crisis, to recovery. Health-compromising behaviors (smoking, heavy drinking, sugared soft drinks, sweets, fast food, and tanning) declined during the crisis, and all but sweets continued to decline during the recovery. Health-promoting behaviors (consumption of fruit, fish oil, and vitamins/minerals and getting recommended sleep) followed more idiosyncratic paths. Overall, most behaviors reverted back to their pre-crisis levels or trends during the recovery, and these short-term deviations in trajectories were probably too short-lived in this recession to have major impacts on health or mortality. A notable exception is for binge drinking, which declined by 10% during the 2 crisis years, continued to fall (at a slower rate of 8%) during the 3 recovery years, and did not revert back to the upward pre-crisis trend during our observation period. These lingering effects, which directionally run counter to the pre-crisis upward trend in consumption and do not reflect price increases during the recovery period, suggest that alcohol is a potential pathway by which recessions improve health and/or reduce mortality. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Cost-effectiveness of hepatitis B vaccination of prison inmates.

    Science.gov (United States)

    Pisu, Maria; Meltzer, Martin Isaac; Lyerla, Rob

    2002-12-13

    The purpose of this paper is to determine the cost-effectiveness of vaccinating inmates against hepatitis B. From the prison perspective, vaccinating inmates at intake is not cost-saving. It could be economically beneficial when the cost of a vaccine dose is US dollars 30 per dose, or there is no prevalence of infection upon intake, or the costs of treating acute or chronic disease are about 70% higher than baseline costs, or the incidence of infection during and after custody were >1.6 and 50%, respectively. The health care system realizes net savings even when there is no incidence in prison, or there is no cost of chronic liver disease, or when only one dose of vaccine is administered. Thus, while prisons might not have economic incentives to implement hepatitis B vaccination programs, the health care system would benefit from allocating resources to them.

  19. The cost effectiveness of intracyctoplasmic sperm injection (ICSI).

    Science.gov (United States)

    Hollingsworth, Bruce; Harris, Anthony; Mortimer, Duncan

    2007-12-01

    To estimate the incremental cost effectiveness of ICSI, and total costs for the population of Australia. Treatment effects for three patient groups were drawn from a published systematic review and meta-analysis of trials comparing fertilisation outcomes for ICSI. Incremental costs derived from resource-based costing of ICSI and existing practice comparators for each patient group. Incremental cost per live birth for patients unsuited to IVF is estimated between A$8,500 and 13,400. For the subnormal semen indication, cost per live birth could be as low as A$3,600, but in the worst case scenario, there would just be additional incremental costs of A$600 per procedure. Multiplying out the additional costs of ICSI over the relevant target populations in Australia gives potential total financial implications of over A$31 million per annum. While there are additional benefits from ICSI procedure, particularly for those with subnormal sperm, the additional cost for the health care system is substantial.

  20. Argonne's Expedited Site Characterization: An integrated approach to cost- and time-effective remedial investigation

    International Nuclear Information System (INIS)

    Burton, J.C.; Walker, J.L.; Aggarwal, P.K.; Meyer, W.T.

    1995-01-01

    Argonne National Laboratory has developed a methodology for remedial site investigation that has proven to be both technically superior to and more cost- and time-effective than traditional methods. This methodology is referred to as the Argonne Expedited Site Characterization (ESC). Quality is the driving force within the process. The Argonne ESC process is abbreviated only in time and cost and never in terms of quality. More usable data are produced with the Argonne ESC process than with traditional site characterization methods that are based on statistical-grid sampling and multiple monitoring wells. This paper given an overview of the Argonne ESC process and compares it with traditional methods for site characterization. Two examples of implementation of the Argonne ESC process are discussed to illustrate the effectiveness of the process in CERCLA (Comprehensive Environmental Response, Compensation, and Liability Act) and RCRA (Resource Conservation and Recovery Act) programs

  1. Clinical benefits, costs, and cost-effectiveness of neonatal intensive care in Mexico.

    Directory of Open Access Journals (Sweden)

    Jochen Profit

    2010-12-01

    Full Text Available Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico.A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs, and incremental cost-effectiveness ratios (ICERs for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24-26, 27-29, and 30-33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24-26, 27-29, and 30-33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses

  2. Geostatistics and cost-effective environmental remediation

    International Nuclear Information System (INIS)

    Rautman, C.A.

    1996-01-01

    Numerous sites within the U.S. Department of Energy (DOE) complex have been contaminated with various radioactive and hazardous materials by defense-related activities during the post-World War II era. The perception is that characterization and remediation of these contaminated sites will be too costly using currently available technology. Consequently, the DOE Office of Technology Development has funded development of a number of alternative processes for characterizing and remediating these sites. The former Feed-Materials Processing Center near Fernald, Ohio (USA), was selected for demonstrating several innovative technologies. Contamination at the Fernald site consists principally of particulate uranium and derivative compounds in surficial soil. A field-characterization demonstration program was conducted during the summer of 1994 specifically to demonstrate the relative economic performance of seven proposed advanced-characterization tools for measuring uranium activity of in-situ soils. These innovative measurement technologies are principally radiation detectors of varied designs. Four industry-standard measurement technologies, including conventional, regulatory-agency-accepted soil sampling followed by laboratory geochemical analysis, were also demonstrated during the program for comparative purposes. A risk-based economic-decision model has been used to evaluate the performance of these alternative characterization tools. The decision model computes the dollar value of an objective function for each of the different characterization approaches. The methodology not only can assist site operators to choose among engineering alternatives for site characterization and/or remediation, but also can provide an objective and quantitative basis for decisions with respect to the completeness of site characterization

  3. Analyses of Blood Bank Efficiency, Cost-Effectiveness and Quality

    Science.gov (United States)

    Lam, Hwai-Tai Chen

    In view of the increasing costs of hospital care, it is essential to investigate methods to improve the labor efficiency and the cost-effectiveness of the hospital technical core in order to control costs while maintaining the quality of care. This study was conducted to develop indices to measure efficiency, cost-effectiveness, and the quality of blood banks; to identify factors associated with efficiency, cost-effectiveness, and quality; and to generate strategies to improve blood bank labor efficiency and cost-effectiveness. Indices developed in this study for labor efficiency and cost-effectiveness were not affected by patient case mix and illness severity. Factors that were associated with labor efficiency were identified as managerial styles, and organizational designs that balance workload and labor resources. Medical directors' managerial involvement was not associated with labor efficiency, but their continuing education and specialty in blood bank were found to reduce the performance of unnecessary tests. Surprisingly, performing unnecessary tests had no association with labor efficiency. This suggested the existence of labor slack in blood banks. Cost -effectiveness was associated with workers' benefits, wages, and the production of high-end transfusion products by hospital-based donor rooms. Quality indices used in this study included autologous transfusion rates, platelet transfusion rates, and the check points available in an error-control system. Because the autologous transfusion rate was related to patient case mix, severity of illness, and possible inappropriate transfusion, it was not recommended to be used for quality index. Platelet-pheresis transfusion rates were associated with the transfusion preferences of the blood bank medical directors. The total number of check points in an error -control system was negatively associated with government ownership and workers' experience. Recommendations for improving labor efficiency and cost-effectiveness

  4. The cost-effectiveness of rotavirus vaccination in Armenia.

    Science.gov (United States)

    Jit, Mark; Yuzbashyan, Ruzanna; Sahakyan, Gayane; Avagyan, Tigran; Mosina, Liudmila

    2011-11-08

    The cost-effectiveness of introducing infant rotavirus vaccination in Armenia in 2012 using Rotarix(R) was evaluated using a multiple birth cohort model. The model considered the cost and health implications of hospitalisations, primary health care consultations and episodes not leading to medical care in children under five years old. Rotavirus vaccination is expected to cost the Ministry of Health $220,000 in 2012, rising to $830,000 in 2016 following termination of GAVI co-financing, then declining to $260,000 in 2025 due to vaccine price maturity. It may reduce health care costs by $34,000 in the first year, rising to $180,000 by 2019. By 2025, vaccination may be close to cost saving to the Ministry of Health if the vaccine purchase price declines as expected. Once coverage has reached high levels, vaccination may prevent 25,000 cases, 3000 primary care consultations, 1000 hospitalisations and 8 deaths per birth cohort vaccinated. The cost per disability-adjusted life year (DALY) saved is estimated to be about $650 from the perspective of the Ministry of Health, $850 including costs accrued to both the Ministry and to GAVI, $820 from a societal perspective excluding indirect costs and $44 from a societal perspective including indirect costs. Since the gross domestic product per capita of Armenia in 2008 was $3800, rotavirus vaccination is likely to be regarded as "very cost-effective" from a WHO standpoint. Vaccination may still be "very cost-effective" if less favourable assumptions are used regarding vaccine price and disease incidence, as long as DALYs are not age-weighted. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laurberg, Ida; Christensen, Finn B

    2008-01-01

    Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full......-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evaluation i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen...... with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion...

  6. The effect of follicular fluid hormones on oocyte recovery after ovarian stimulation: FSH level predicts oocyte recovery

    Directory of Open Access Journals (Sweden)

    Rinaudo Paolo F

    2009-04-01

    Full Text Available Abstract Background Ovarian stimulation for assisted reproductive technology (ART overcomes the physiologic process to develop a single dominant follicle. However, following stimulation, egg recovery rates are not 100%. The objective of this study is to determine if the follicular fluid hormonal environment is associated with oocyte recovery. Methods This is a prospective study involving patients undergoing ART by standard ovarian stimulation protocols at an urban academic medical center. A total of 143 follicular fluid aspirates were collected from 80 patients. Concentrations of FSH, hCG, estradiol, progesterone, testosterone and prolactin were determined. A multivariable regression analysis was used to investigate the relationship between the follicular fluid hormones and oocyte recovery. Results Intrafollicular FSH was significantly associated with oocyte recovery after adjustment for hCG (Adjusted odds ratio (AOR = 1.21, 95%CI 1.03–1.42. The hCG concentration alone, in the range tested, did not impact the odds of oocyte recovery (AOR = 0.99, 95%CI 0.93–1.07. Estradiol was significantly associated with oocyte recovery (AOR = 0.98, 95% CI 0.96–0.99. After adjustment for progesterone, the strength of association between FSH and oocyte recovery increased (AOR = 1.84, 95%CI 1.45–2.34. Conclusion The relationship between FSH and oocyte recovery is significant and appears to work through mechanisms independent of the sex hormones. FSH may be important for the physiologic event of separation of the cumulus-oocyte complex from the follicle wall, thereby influencing oocyte recovery. Current methods for inducing the final stages of oocyte maturation, with hCG administration alone, may not be optimal. Modifications of treatment protocols utilizing additional FSH may enhance oocyte recovery.

  7. Tubular Scaffold with Shape Recovery Effect for Cell Guide Applications

    Directory of Open Access Journals (Sweden)

    Kazi M. Zakir Hossain

    2015-07-01

    Full Text Available Tubular scaffolds with aligned polylactic acid (PLA fibres were fabricated for cell guide applications by immersing rolled PLA fibre mats into a polyvinyl acetate (PVAc solution to bind the mats. The PVAc solution was also mixed with up to 30 wt % β-tricalcium phosphate (β-TCP content. Cross-sectional images of the scaffold materials obtained via scanning electron microscopy (SEM revealed the aligned fibre morphology along with a significant number of voids in between the bundles of fibres. The addition of β-TCP into the scaffolds played an important role in increasing the void content from 17.1% to 25.3% for the 30 wt % β-TCP loading, which was measured via micro-CT (µCT analysis. Furthermore, µCT analyses revealed the distribution of aggregated β-TCP particles in between the various PLA fibre layers of the scaffold. The compressive modulus properties of the scaffolds increased from 66 MPa to 83 MPa and the compressive strength properties decreased from 67 MPa to 41 MPa for the 30 wt % β-TCP content scaffold. The scaffolds produced were observed to change into a soft and flexible form which demonstrated shape recovery properties after immersion in phosphate buffered saline (PBS media at 37 °C for 24 h. The cytocompatibility studies (using MG-63 human osteosarcoma cell line revealed preferential cell proliferation along the longitudinal direction of the fibres as compared to the control tissue culture plastic. The manufacturing process highlighted above reveals a simple process for inducing controlled cell alignment and varying porosity features within tubular scaffolds for potential tissue engineering applications.

  8. The long read t recovery: treatment outcome and cost among adolescents treated for anorexia nervosa in specialized care.

    Science.gov (United States)

    Silén, Yasmina; Raevuori, Anu; Sipilä, Pyry; Jüriloo, Elisabeth; Tainio, Veli-Matti; Marttunen, Mauri; Keski-Rahkonen, Anna

    We investigated factors affecting treatment outcome and cost of treatment among adolescents treated for anorexia nervosa in specialized care. Records of 47 patients with anorexia nervosa treated at the adolescent eating disorder unit were reviewed retrospectively. Individual differences in the need for treatment and cost of treatment were considerable. Nearly one third of patients required treatment at multiple wards in addition to outpatient care. The majority of costs (76%) incurred from treating a minority (29 %) of patients. Psychiatric comorbidity, particularly depression, was associated with a greater need for treatment and higher costs. The cost of treatment of anorexia nervosa is considerable, but many of those requiring intensive treatment have a favorable outcome.

  9. Effects of cost metric on cost-effectiveness of protected-area network design in urban landscapes.

    Science.gov (United States)

    Burkhalter, J C; Lockwood, J L; Maslo, B; Fenn, K H; Leu, K

    2016-04-01

    A common goal in conservation planning is to acquire areas that are critical to realizing biodiversity goals in the most cost-effective manner. The way monetary acquisition costs are represented in such planning is an understudied but vital component to realizing cost efficiencies. We sought to design a protected-area network within a forested urban region that would protect 17 birds of conservation concern. We compared the total costs and spatial structure of the optimal protected-area networks produced using three acquisition-cost surrogates (area, agricultural land value, and tax-assessed land value). Using the tax-assessed land values there was a 73% and 78% cost savings relative to networks derived using area or agricultural land value, respectively. This cost reduction was due to the considerable heterogeneity in acquisition costs revealed in tax-assessed land values, especially for small land parcels, and the corresponding ability of the optimization algorithm to identify lower-cost parcels for inclusion that had equal value to our target species. Tax-assessed land values also reflected the strong spatial differences in acquisition costs (US$0.33/m(2)-$55/m(2)) and thus allowed the algorithm to avoid inclusion of high-cost parcels when possible. Our results add to a nascent but growing literature that suggests conservation planners must consider the cost surrogate they use when designing protected-area networks. We suggest that choosing cost surrogates that capture spatial- and size-dependent heterogeneity in acquisition costs may be relevant to establishing protected areas in urbanizing ecosystems. © 2015 Society for Conservation Biology.

  10. Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer.

    Science.gov (United States)

    Mafé, Juan J; Planelles, Beatriz; Asensio, Santos; Cerezal, Jorge; Inda, María-Del-Mar; Lacueva, Javier; Esteban, Maria-Dolores; Hernández, Luis; Martín, Concepción; Baschwitz, Benno; Peiró, Ana M

    2017-08-01

    Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed. One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05). The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.

  11. Cost-effectiveness of rotavirus vaccination in Albania.

    Science.gov (United States)

    Ahmeti, Albana; Preza, Iria; Simaku, Artan; Nelaj, Erida; Clark, Andrew David; Felix Garcia, Ana Gabriela; Lara, Carlos; Hoestlandt, Céline; Blau, Julia; Bino, Silvia

    2015-05-07

    Rotavirus vaccines have been introduced in several European countries but can represent a considerable cost, particularly for countries that do not qualify for any external financial support. This study aimed to evaluate the cost-effectiveness of introducing rotavirus vaccination into Albania's national immunization program and to inform national decision-making by improving national capacity to conduct economic evaluations of new vaccines. The TRIVAC model was used to assess vaccine impact and cost-effectiveness. The model estimated health and economic outcomes attributed to 10 successive vaccinated birth cohorts (2013-2022) from a government and societal perspective. Epidemiological and economic data used in the model were based on national cost studies, and surveillance data, as well as estimates from the scientific literature. Cost-effectiveness was estimated for both the monovalent (RV1) and pentavalent vaccines (RV5). A multivariate scenario analysis (SA) was performed to evaluate the uncertainty around the incremental cost-effectiveness ratios (ICERs). With 3% discounting of costs and health benefits over the period 2013-2022, rotavirus vaccination in Albania could avert 51,172 outpatient visits, 14,200 hospitalizations, 27 deaths, 950 disability-adjusted life-years (DALYs), and gain 801 life-years. When both vaccines were compared to no vaccination, the discounted cost per DALY averted was US$ 2008 for RV1 and US$ 5047 for RV5 from a government perspective. From the societal perspective the values were US$ 517 and US$ 3556, respectively. From both the perspectives, the introduction of rotavirus vaccine to the Albanian immunization schedule is either cost-effective or highly cost-effective for a range of plausible scenarios. In most scenarios, including the base-case scenario, the discounted cost per DALY averted was less than three times the gross domestic product (GDP) per capita. However, rotavirus vaccination was not cost-effective when rotavirus cases

  12. Cost effectiveness of facility and home based HIV voluntary ...

    African Journals Online (AJOL)

    Cost effectiveness of facility and home based HIV voluntary counseling and ... Background: In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) ... AJOL African Journals Online.

  13. Cost-effectiveness and radiation risk of breast cancer screening

    International Nuclear Information System (INIS)

    Rombach, J.J.

    1987-01-01

    Base cost effectiveness risk associated with radiological screening for tuberculosis and lung tumor the Government of Netherlands advised against mass screening. However, mass screening remains an important method in the case of breast cancer

  14. Bioinformatics tools for development of fast and cost effective simple ...

    African Journals Online (AJOL)

    Bioinformatics tools for development of fast and cost effective simple sequence repeat ... comparative mapping and exploration of functional genetic diversity in the ... Already, a number of computer programs have been implemented that aim at ...

  15. Determining the Effect (the Social Costs) of Exclusion under the ...

    African Journals Online (AJOL)

    Determining the Effect (the Social Costs) of Exclusion under the South African Exclusionary Rule: Should Factual Guilt Tilt the Scales in Favour of the Admission of Unconstitutionally Obtained Evidence?

  16. Cost-effectiveness of osteo-odonto keratoprosthesis in Singapore.

    Science.gov (United States)

    Dong, Di; Tan, Anna; Mehta, Jodhbir S; Tan, Donald; Finkelstein, Eric Andrew

    2014-01-01

    To determine the long-term cost-effectiveness of osteo-odonto keratoprosthesis (OOKP) relative to no treatment among patients with end-stage corneal and ocular surface diseases in Singapore. Cost-effectiveness analysis based on data from a retrospective cohort study. From a health system perspective, we calculated the incremental cost-effectiveness ratio of OOKP treatment relative to no treatment over a 30-year horizon, based on data from a cohort of 23 patients who underwent OOKP surgery between 2004 and 2009 at Singapore National Eye Centre. Preoperative and postoperative vision-related quality-of-life values were estimated from patients' visual outcomes and were used to calculate the gain in quality-adjusted life years (QALYs) resulting from OOKP treatment. Unsubsidized costs for surgery, consultations, examinations, medications, follow-up visits, and treatments for complications were retrieved from patients' bills to estimate the total costs associated with OOKP treatment. Sensitivity analyses were conducted to test the robustness of the model. Over a 30-year period, OOKP treatment, compared with no treatment, improved QALYs by 3.991 among patients with end-stage corneal and ocular surface diseases at an additional cost of S$67 840 (US$55 150), resulting in an incremental cost-effectiveness ratio of S$17 000/QALY (US$13 820/QALY). Based on commonly cited cost-effectiveness benchmarks, the OOKP is a cost-effective treatment for patients with end-stage corneal and ocular surface diseases. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. A Cost-effectiveness Analysis of Early vs Late Tracheostomy.

    Science.gov (United States)

    Liu, C Carrie; Rudmik, Luke

    2016-10-01

    The timing of tracheostomy in critically ill patients requiring mechanical ventilation is controversial. An important consideration that is currently missing in the literature is an evaluation of the economic impact of an early tracheostomy strategy vs a late tracheostomy strategy. To evaluate the cost-effectiveness of the early tracheostomy strategy vs the late tracheostomy strategy. This economic analysis was performed using a decision tree model with a 90-day time horizon. The economic perspective was that of the US health care third-party payer. The primary outcome was the incremental cost per tracheostomy avoided. Probabilities were obtained from meta-analyses of randomized clinical trials. Costs were obtained from the published literature and the Healthcare Cost and Utilization Project database. A multivariate probabilistic sensitivity analysis was performed to account for uncertainty surrounding mean values used in the reference case. The reference case demonstrated that the cost of the late tracheostomy strategy was $45 943.81 for 0.36 of effectiveness. The cost of the early tracheostomy strategy was $31 979.12 for 0.19 of effectiveness. The incremental cost-effectiveness ratio for the late tracheostomy strategy compared with the early tracheostomy strategy was $82 145.24 per tracheostomy avoided. With a willingness-to-pay threshold of $50 000, the early tracheostomy strategy is cost-effective with 56% certainty. The adaptation of an early vs a late tracheostomy strategy depends on the priorities of the decision-maker. Up to a willingness-to-pay threshold of $80 000 per tracheostomy avoided, the early tracheostomy strategy has a higher probability of being the more cost-effective intervention.

  18. Effects of optimism on recovery and mental health after a tornado outbreak.

    Science.gov (United States)

    Carbone, Eric G; Echols, Erin Thomas

    2017-05-01

    Dispositional optimism, a stable expectation that good things will happen, has been shown to improve health outcomes in a wide range of contexts, but very little research has explored the impact of optimism on post-disaster health and well-being. Data for this study come from the Centers for Disease Control and Prevention's Public health systems and mental health community recovery (PHSMHCR) Survey. Participants included 3216 individuals living in counties affected by the April 2011 tornado outbreak in Mississippi and Alabama. This study assesses the effect of dispositional optimism on post-disaster recovery and mental health. Dispositional optimism was found to have a positive effect on personal recovery and mental health after the disaster. Furthermore, it moderated the relationship between level of home damage and personal recovery as well as the relationship between home damage and post-traumatic stress disorder (PTSD), with stronger effects for those with increased levels of home damage. The utility of screening for optimism is discussed, along with the potential for interventions to increase optimism as a means of mitigating adverse mental health effects and improving the recovery of individuals affected by disasters and other traumatic events.

  19. Effect of prospective reimbursement on nursing home costs.

    OpenAIRE

    Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

    1993-01-01

    OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and ...

  20. Cost-effectiveness of private umbilical cord blood banking.

    Science.gov (United States)

    Kaimal, Anjali J; Smith, Catherine C; Laros, Russell K; Caughey, Aaron B; Cheng, Yvonne W

    2009-10-01

    To investigate the cost-effectiveness of private umbilical cord blood banking. A decision-analytic model was designed comparing private umbilical cord blood banking with no umbilical cord blood banking. Baseline assumptions included a cost of $3,620 for umbilical cord blood banking and storage for 20 years, a 0.04% chance of requiring an autologous stem cell transplant, a 0.07% chance of a sibling requiring an allogenic stem cell transplant, and a 50% reduction in risk of graft-versus-host disease if a sibling uses banked umbilical cord blood. Private cord blood banking is not cost-effective because it cost an additional $1,374,246 per life-year gained. In sensitivity analysis, if the cost of umbilical cord blood banking is less than $262 or the likelihood of a child needing a stem cell transplant is greater than 1 in 110, private umbilical cord blood banking becomes cost-effective. Currently, private umbilical cord blood banking is cost-effective only for children with a very high likelihood of needing a stem cell transplant. Patients considering private blood banking should be informed of the remote likelihood that a unit will be used for a child or another family member. III.

  1. Cost-effectiveness analysis of computer-based assessment

    Directory of Open Access Journals (Sweden)

    Pauline Loewenberger

    2003-12-01

    Full Text Available The need for more cost-effective and pedagogically acceptable combinations of teaching and learning methods to sustain increasing student numbers means that the use of innovative methods, using technology, is accelerating. There is an expectation that economies of scale might provide greater cost-effectiveness whilst also enhancing student learning. The difficulties and complexities of these expectations are considered in this paper, which explores the challenges faced by those wishing to evaluate the costeffectiveness of computer-based assessment (CBA. The paper outlines the outcomes of a survey which attempted to gather information about the costs and benefits of CBA.

  2. The effect of family characteristics on the recovery of burn injuries in children.

    Science.gov (United States)

    Sheridan, Robert L; Lee, Austin F; Kazis, Lewis E; Liang, Matthew H; Li, Nien-Chen; Hinson, Michelle I; Bauk, Helena; Meyer, Walter J; Stubbs, Teresa K; Palmieri, Tina L; Tompkins, Ronald G

    2012-09-01

    Interactions between family members and characteristics of family life and function may affect a child's recovery from burn injury. We prospectively examined the relationship between family characteristics and physical and psychosocial recovery from burns. The families of 399 burned children aged 5 years to 18 years admitted to one of four Shriners Hospitals for Children for management of acute burns completed the Family Environment Scale within 7 days of admission and then the American Burn Association/Shriners Hospitals for Children Burn Outcome Questionnaire (BOQ) at baseline, 3, 6, 12, 18, 24, 36, and 48 months. Generalized estimating equations with random effects for the time since burn were used to track recovery of the BOQ patient-centered domains associated with baseline family characteristics during the course of the study. The children had a mean age of 11 years and burn size of 32% total body surface area burned. Higher Family Environment Scale scores in cohesion, independence, organization, and active recreational orientation were associated with significantly better rates of recovery in multiple BOQ domains of health-related quality of life. Higher scores in conflict and achievement orientation predicted statistically significant impaired recovery. Higher expressiveness predicted greater difficulty with school reentry. Family characteristics affect the recovery of children after serious burns. Some of these may be amenable to focused anticipatory family interventions to help optimize outcomes. In particular, those characteristics that impair school reentry should be targeted.

  3. Effectiveness evaluation of whole-body electromyostimulation as a post-exercise recovery method.

    Science.gov (United States)

    DE LA Camara, Miguel A; Pardos, Ana I; Veiga, Óscar L

    2018-01-04

    Whole-body electromyostimulation (WB-EMS) devices are now being used in health and sports training, although there are few studies investigating their benefits. The objective of this research was to evaluate the effectiveness of WB-EMS as a post-exercise recovery method, and compare it with other methods like active and passive recovery. The study included nine trained men (age = 21 ± 1years, height = 1.77 ± 0.4 m, mass = 62 ± 7 kg). Three trials were performed in three different sessions, 1 week apart. Each trial, the participants completed the same exercise protocol and a different recovery method each time. A repeated measures design was used to check the basal reestablishing on several physiological variables [lactate, heart rate, percentage of tissue hemoglobin saturation, temperature, and neuromuscular fatigue] and to evaluate the quality of recovery. The non-parametric Wilcoxon and Friedman ANOVA tests were used to examine the differences between recovery methods. The results showed no differences between methods in the physiological and psychological variables analyzed. Although, the blood lactate concentration showed borderline statistical significance between methods (P = 0.050). Likewise, WB-EMS failed to recover baseline blood lactate concentration (P = 0.021) and percentage of tissue hemoglobin saturation (P = 0.023), in contrast to the other two methods. These findings suggest that WB-EMS is not a good recovery method because the power of reestablishing of several physiological and psychological parameters is not superior to other recovery methods like active and passive recovery.

  4. Cost effectiveness of teratology counseling - the Motherisk experience.

    Science.gov (United States)

    Koren, Gideon; Bozzo, Pina

    2014-01-01

    While the benefits of evidence-based counseling to large numbers of women and physicians are intuitively evident, there is an urgent need to document that teratology counseling, in addition to improving the quality of life of women and families, also leads to cost saving. The objective of the present study was to calculate the cost effectiveness of the Motherisk Program, a large teratology information and counseling service at The Hospital for Sick Children and the University of Toronto. We analyzed data from the Motherisk Program on its 2012 activities in two domains: 1) Calculation of cost-saving in preventing unjustified pregnancy terminations; and 2) prevention of major birth defects. Cost of pregnancy termination and lifelong cost of specific birth defects were identified from primary literature and prorated for cost of living for the year 2013. Prevention of 255 pregnancy terminations per year led to cost savings of $516,630. The total estimated number of major malformations prevented by Motherisk counseling in 2012 was 8.41 cases at a total estimated cost of $9,032,492. With an estimated minimum annual prevention of 8 major malformations, and numerous unnecessary terminations of otherwise- wanted pregnancies, a cost saving of $10 million can be calculated. In 2013 the operating budget of Motherisk counseling totaled $640,000. Even based on the narrow range of activities for which we calculated cost, this service is highly cost- effective. Because most teratology counseling services are operating in a very similar method to Motherisk, it is fair to assume that these results, although dependent on the size of the service, are generalizable to other countries.

  5. Cost effectiveness of a pentavalent rotavirus vaccine in Oman.

    Science.gov (United States)

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

    2014-06-17

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

  6. New method for evaluating effective recovery time and single photoelectron response in silicon photomultipliers

    Energy Technology Data Exchange (ETDEWEB)

    Grodzicka, Martyna, E-mail: m.grodzicka@ncbj.gov.pl; Szczęśniak, Tomasz; Moszyński, Marek; Szawłowski, Marek; Grodzicki, Krystian

    2015-05-21

    The linearity of a silicon photomultiplier (SiPM) response depends on the number of APD cells and its effective recovery time and it is related to the intensity and duration of the detected light pulses. The aim of this study was to determine the effective recovery time on the basis of the measured SiPM response to light pulses of different durations. A closer analysis of the SiPM response to the light pulses shorter than the effective recovery time of APD cells led to a method for the evaluation of the single photoelectron response of the devices where the single photoelectron peak cannot be clearly measured. This is necessary in the evaluation of the number of fired APD cells (or the number of photoelectrons) in measurements with light pulses of various durations. Measurements were done with SiPMs manufactured by two companies: Hamamatsu and SensL.

  7. Cost-effectiveness of screening for asymptomatic carotid atherosclerotic disease.

    Science.gov (United States)

    Derdeyn, C P; Powers, W J

    1996-11-01

    The value of screening for asymptomatic carotid stenosis has become an important issue with the recently reported beneficial effect of endarterectomy. The purpose of this study is to evaluate the cost-effectiveness of using Doppler ultrasound as a screening tool to select subjects for arteriography and subsequent surgery. A computer model was developed to simulate the cost-effectiveness of screening a cohort of 1000 men during a 20-year period. The primary outcome measure was incremental present-value dollar expenditures for screening and treatment per incremental present-value quality-adjusted life-year (QALY) saved. Estimates of disease prevalence and arteriographic and surgical complication rates were obtained from the literature. Probabilities of stroke and death with surgical and medical treatment were obtained from published clinical trials. Doppler ultrasound sensitivity and specificity were obtained through review of local experience. Estimates of costs were obtained from local Medicare reimbursement data. A one-time screening program of a population with a high prevalence (20%) of > or = 60% stenosis cost $35130 per incremental QALY gained. Decreased surgical benefit or increased annual discount rate was detrimental, resulting in lost QALYs. Annual screening cost $457773 per incremental QALY gained. In a low-prevalence (4%) population, one-time screening cost $52588 per QALY gained, while annual screening was detrimental. The cost-effectiveness of a one-time screening program for an asymptomatic population with a high prevalence of carotid stenosis may be cost-effective. Annual screening is detrimental. The most sensitive variables in this simulation model were long-term stroke risk reduction after surgery and annual discount rate for accumulated costs and QALYs.

  8. Recovery of Normal Body Weight in Adolescents with Anorexia Nervosa: The Nurses’ Perspective on Effective Interventions

    NARCIS (Netherlands)

    Annemarie van Elburg; prof Berno van Meijel; Esther Meerwijk; Laura Beukers; Joyce van Ommen; René Bakker

    2011-01-01

    Little is known about effective nursing interventions for adolescents with anorexia nervosa. The purpose of this study was to discover which aspects of nursing care are most effective, according to nurses, in recovery of normal body weight in adolescents with anorexia nervosa. METHODS: A qualitative

  9. Cost-effectiveness of a central venous catheter care bundle.

    Directory of Open Access Journals (Sweden)

    Kate A Halton

    Full Text Available BACKGROUND: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI. Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. METHODS AND FINDINGS: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters, or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds. CONCLUSIONS: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision

  10. 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

  11. Re-evaluation of the effectiveness of the central A/M Area recovery well network

    International Nuclear Information System (INIS)

    Haselow, J.S.

    1991-06-01

    A groundwater recovery well network has been operating in the central portion of the A/M Area of the Savannah River Site (SRS) since 1985 to retrieve chlorinated volatile organic solvents. In 1986, a groundwater modeling study was performed to evaluate the effectiveness of the recovery well network that included planned recovery wells (RWM 1 through 11) and process water wells (S. S. Papadopulous, 1986). Since the original modeling study, use of some of the process wells has discontinued and some pumping rates at other wells have changed. Also, the understanding of the hydrologic system in the A/M Area has improved because additional monitoring wells have been installed in the area. As a result, an updated groundwater flow model (Beaudoin et al., 1991) for the area was used to evaluate the effectiveness of the existing recovery network. The results of this study indicate that the estimated effectiveness of the recovery well has not changed dramatically since the original groundwater modeling study. However, slight differences do exist between the original study and this study because the recent model more accurately reflects the A/M Area subsurface hydrologic system

  12. Cost Effective Technologies and Renewable Substrates for Biosurfactants’ Production

    Directory of Open Access Journals (Sweden)

    Ibrahim M Banat

    2014-12-01

    Full Text Available Diverse types of microbial surface-active amphiphilic molecules are produced by a range of microbial communities. The extraordinary properties of biosurfactant / bioemulsifier (BS/BE as surface active products allows them to have key roles in various field of applications such as bioremediation, biodegradation, enhanced oil recovery, pharmaceutics, food processing among many others. This leads to a vast number of potential applications of these BS/BE in different industrial sectors. Despite the huge number of reports and patents describing BS and BE applications and advantages, commercialization of these compounds remain difficult, costly and to a large extent irregular. This is mainly due to the usage of chemically synthesized media for growing producing microorganism and in turn the production of preferred quality products. It is important to note that although a number of developments have taken place in the field of biosurfactant industries, large scale production remains economically challenging for many types of these products. This is mainly due to the huge monetary difference between the investment and achievable productivity from the commercial point of view. This review discusses low cost, renewable raw substrates and fermentation technology in BS/BE production processes and their role in reducing the production cost.

  13. Cost-effectiveness analysis in minimally invasive spine surgery.

    Science.gov (United States)

    Al-Khouja, Lutfi T; Baron, Eli M; Johnson, J Patrick; Kim, Terrence T; Drazin, Doniel

    2014-06-01

    Medical care has been evolving with the increased influence of a value-based health care system. As a result, more emphasis is being placed on ensuring cost-effectiveness and utility in the services provided to patients. This study looks at this development in respect to minimally invasive spine surgery (MISS) costs. A literature review using PubMed, the Cost-Effectiveness Analysis (CEA) Registry, and the National Health Service Economic Evaluation Database (NHS EED) was performed. Papers were included in the study if they reported costs associated with minimally invasive spine surgery (MISS). If there was no mention of cost, CEA, cost-utility analysis (CUA), quality-adjusted life year (QALY), quality, or outcomes mentioned, then the article was excluded. Fourteen studies reporting costs associated with MISS in 12,425 patients (3675 undergoing minimally invasive procedures and 8750 undergoing open procedures) were identified through PubMed, the CEA Registry, and NHS EED. The percent cost difference between minimally invasive and open approaches ranged from 2.54% to 33.68%-all indicating cost saving with a minimally invasive surgical approach. Average length of stay (LOS) for minimally invasive surgery ranged from 0.93 days to 5.1 days compared with 1.53 days to 12 days for an open approach. All studies reporting EBL reported lower volume loss in an MISS approach (range 10-392.5 ml) than in an open approach (range 55-535.5 ml). There are currently an insufficient number of studies published reporting the costs of MISS. Of the studies published, none have followed a standardized method of reporting and analyzing cost data. Preliminary findings analyzing the 14 studies showed both cost saving and better outcomes in MISS compared with an open approach. However, more Level I CEA/CUA studies including cost/QALY evaluations with specifics of the techniques utilized need to be reported in a standardized manner to make more accurate conclusions on the cost effectiveness of

  14. Cost-effective conservation planning: lessons from economics.

    Science.gov (United States)

    Duke, Joshua M; Dundas, Steven J; Messer, Kent D

    2013-08-15

    Economists advocate that the billions of public dollars spent on conservation be allocated to achieve the largest possible social benefit. This is "cost-effective conservation"-a process that incorporates both monetized benefits and costs. Though controversial, cost-effective conservation is poorly understood and rarely implemented by planners. Drawing from the largest publicly financed conservation programs in the United States, this paper seeks to improve the communication from economists to planners and to overcome resistance to cost-effective conservation. Fifteen practical lessons are distilled, including the negative implications of limiting selection with political constraints, using nonmonetized benefit measures or benefit indices, ignoring development risk, using incomplete cost measures, employing cost measures sequentially, and using benefit indices to capture costs. The paper highlights interrelationships between benefits and complications such as capitalization and intertemporal planning. The paper concludes by identifying the challenges at the research frontier, including incentive problems associated with adverse selection, additionality, and slippage. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Cost effectiveness of reducing radon exposure in Spanish dwellings

    International Nuclear Information System (INIS)

    Colgan, P.A.; Gutierrez, J.

    1996-01-01

    Published information on the distribution of radon levels in Spanish single family dwellings is used to evaluate the cost-effectiveness of three different intervention scenarios: remediation of existing dwellings, radon proofing of all future dwellings and the targetting of areas with higher than average indoor radon concentrations. Analysis is carried out on the basis of a Reference Level of 400 Bq m -3 for the existing housing stock and 200 Bq m -3 for new dwellings. Certain assumptions are made about the effectiveness and durability of the measures applied and annualised costs are used to calculate the costs per lung cancer death averted. The results reveal that targetting future housing is a more cost-effective option than remediation of existing dwellings with radon concentrations above the Reference Level -the costs per lung cancer death averted are typically $145000. In high-risk areas, these costs can be considerably less, depending on the percentage of dwellings expected to exceed the Reference Level and the average savings in exposure as a result of the intervention. The costs of intervention to reduce lung cancer deaths following exposure to radon compare favourably with those of other health programmes in other countries. (Author)

  16. Cost-effectiveness of hysteroscopy screening for infertile women.

    Science.gov (United States)

    Kasius, Jenneke C; Eijkemans, René J C; Mol, Ben W J; Fauser, Bart C J M; Fatemi, Human M; Broekmans, Frank J M

    2013-06-01

    This study assessed the cost-effectiveness of office hysteroscopy screening prior to IVF. Therefore, the cost-effectiveness of two distinct strategies - hysteroscopy after two failed IVF cycles (Failedhyst) and routine hysteroscopy prior to IVF (Routinehyst) - was compared with the reference strategy of no hysteroscopy (Nohyst). When present, intrauterine pathology was treated during hysteroscopy. Two models were constructed and evaluated in a decision analysis. In model I, all patients had an increase in pregnancy rate after screening hysteroscopy prior to IVF; in model II, only patients with intrauterine pathology would benefit. For each strategy, the total costs and live birth rates after a total of three IVF cycles were assessed. For model I (all patients benefit from hysteroscopy), Routinehyst was always cost-effective compared with Nohyst or Failedhyst. For the Routinehyst strategy, a monetary profit would be obtained in the case where hysteroscopy would increase the live birth rate after IVF by ≥ 2.8%. In model II (only patients with pathology benefit from hysteroscopy), Routinehyst also dominated Failedhyst. However, hysteroscopy performance resulted in considerable costs. In conclusion, the application of a routine hysteroscopy prior to IVF could be cost-effective. However, randomized trials confirming the effectiveness of hysteroscopy are needed. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Effect of parenteral nutrition on the bone marrow recovery under exsperimental conditions of uneven irradiation

    International Nuclear Information System (INIS)

    Moroz, B.B.; Fedorovskij, L.L.; Deshevoj, Yu.B.

    1986-01-01

    Using white rats-males the effect of parenteral nutrition (PN) on blood formation (hemopoiesis) recovery under the conditions of total (control), subtotal (shielding of animal hind limb) with 7.5 Gy and X-ray partial irradiation of abdomen region with the 13.5 Gy has been studied. It has been found that bone marrow recovery increases either at subtotal or partial irradiation under the conditions of PN. Mechanisms of PN favourable effect are discussed. The advisability of using PN under uneven irradiations of organism is indicated

  18. Impact and cost-effectiveness of rotavirus vaccination in Bangladesh.

    Science.gov (United States)

    Pecenka, Clint; Parashar, Umesh; Tate, Jacqueline E; Khan, Jahangir A M; Groman, Devin; Chacko, Stephen; Shamsuzzaman, Md; Clark, Andrew; Atherly, Deborah

    2017-07-13

    Diarrheal disease is a leading cause of child mortality globally, and rotavirus is responsible for more than a third of those deaths. Despite substantial decreases, the number of rotavirus deaths in children under five was 215,000 per year in 2013. Of these deaths, approximately 41% occurred in Asia and 3% of those in Bangladesh. While Bangladesh has yet to introduce rotavirus vaccination, the country applied for Gavi support and plans to introduce it in 2018. This analysis evaluates the impact and cost-effectiveness of rotavirus vaccination in Bangladesh and provides estimates of the costs of the vaccination program to help inform decision-makers and international partners. This analysis used Pan American Health Organization's TRIVAC model (version 2.0) to examine nationwide introduction of two-dose rotavirus vaccination in 2017, compared to no vaccination. Three mortality scenarios (low, high, and midpoint) were assessed. Benefits and costs were examined from the societal perspective over ten successive birth cohorts with a 3% discount rate. Model inputs were locally acquired and complemented by internationally validated estimates. Over ten years, rotavirus vaccination would prevent 4000 deaths, nearly 500,000 hospitalizations and 3 million outpatient visits in the base scenario. With a Gavi subsidy, cost/disability adjusted life year (DALY) ratios ranged from $58/DALY to $142/DALY averted. Without a Gavi subsidy and a vaccine price of $2.19 per dose, cost/DALY ratios ranged from $615/DALY to $1514/DALY averted. The discounted cost per DALY averted was less than the GDP per capita for nearly all scenarios considered, indicating that a routine rotavirus vaccination program is highly likely to be cost-effective. Even in a low mortality setting with no Gavi subsidy, rotavirus vaccination would be cost-effective. These estimates exclude the herd immunity benefits of vaccination, so represent a conservative estimate of the cost-effectiveness of rotavirus vaccination

  19. Cost-effectiveness of rotavirus vaccination in Kenya and Uganda.

    Science.gov (United States)

    Sigei, Charles; Odaga, John; Mvundura, Mercy; Madrid, Yvette; Clark, Andrew David

    2015-05-07

    Rotavirus vaccines have the potential to prevent a substantial amount of life-threatening gastroenteritis in young African children. This paper presents the results of prospective cost-effectiveness analyses for rotavirus vaccine introduction for Kenya and Uganda. In each country, a national consultant worked with a national technical working group to identify appropriate data and validate study results. Secondary data on demographics, disease burden, health utilization, and costs were used to populate the TRIVAC cost-effectiveness model. The baseline analysis assumed an initial vaccine price of $0.20 per dose, corresponding to Gavi, the Vaccine Alliance stipulated copay for low-income countries. The incremental cost-effectiveness of a 2-dose rotavirus vaccination schedule was evaluated for 20 successive birth cohorts from the government perspective in both countries, and from the societal perspective in Uganda. Between 2014 and 2033, rotavirus vaccination can avert approximately 60,935 and 216,454 undiscounted deaths and hospital admissions respectively in children under 5 years in Kenya. In Uganda, the respective number of undiscounted deaths and hospital admission averted is 70,236 and 329,779 between 2016 and 2035. Over the 20-year period, the discounted vaccine program costs are around US$ 80 million in Kenya and US$ 60 million in Uganda. Discounted government health service costs avoided are US$ 30 million in Kenya and US$ 10 million in Uganda (or US$ 18 million including household costs). The cost per disability-adjusted life-year (DALY) averted from a government perspective is US$ 38 in Kenya and US$ 34 in Uganda (US$ 29 from a societal perspective). Rotavirus vaccine introduction is highly cost-effective in both countries in a range of plausible 'what-if' scenarios. The involvement of national experts improves the quality of data used, is likely to increase acceptability of the results in decision-making, and can contribute to strengthened national

  20. Effect of prospective reimbursement on nursing home costs.

    Science.gov (United States)

    Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P

    1993-04-01

    This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.

  1. Cost-effectiveness of the Norwegian breast cancer screening program.

    Science.gov (United States)

    van Luijt, P A; Heijnsdijk, E A M; de Koning, H J

    2017-02-15

    The Norwegian Breast Cancer Screening Programme (NBCSP) has a nation-wide coverage since 2005. All women aged 50-69 years are invited biennially for mammography screening. We evaluated breast cancer mortality reduction and performed a cost-effectiveness analysis, using our microsimulation model, calibrated to most recent data. The microsimulation model allows for the comparison of mortality and costs between a (hypothetical) situation without screening and a situation with screening. Breast cancer incidence in Norway had a steep increase in the early 1990s. We calibrated the model to simulate this increase and included recent costs for screening, diagnosis and treatment of breast cancer and travel and productivity loss. We estimate a 16% breast cancer mortality reduction for a cohort of women, invited to screening, followed over their complete lifetime. Cost-effectiveness is estimated at NOK 112,162 per QALY gained, when taking only direct medical costs into account (the cost of the buses, examinations, and invitations). We used a 3.5% annual discount rate. Cost-effectiveness estimates are substantially below the threshold of NOK 1,926,366 as recommended by the WHO guidelines. For the Norwegian population, which has been gradually exposed to screening, breast cancer mortality reduction for women exposed to screening is increasing and is estimated to rise to ∼30% in 2020 for women aged 55-80 years. The NBCSP is a highly cost-effective measure to reduce breast cancer specific mortality. We estimate a breast cancer specific mortality reduction of 16-30%, at the cost of 112,162 NOK per QALY gained. © 2016 UICC.

  2. Cost-effectiveness of a pressure ulcer quality collaborative

    Directory of Open Access Journals (Sweden)

    Bal Roland

    2010-06-01

    Full Text Available Abstract Background A quality improvement collaborative (QIC in the Dutch long-term care sector (nursing homes, assisted living facilities, home care used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs. The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. Methods We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials. Quality of life (Qol weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1 not sustained, (2 partially sustained, and (3 completely sustained. Results Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol of patients increased by 0.02 Quality Adjusted Life Years (QALYs in two years; healthcare costs increased by €2000 per patient; the Incremental Cost-effectiveness Ratio (ICER was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. Conclusions During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

  3. Cost-effectiveness of a pressure ulcer quality collaborative.

    Science.gov (United States)

    Makai, Peter; Koopmanschap, Marc; Bal, Roland; Nieboer, Anna P

    2010-06-01

    A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained. Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by euro2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

  4. Cost-effectiveness and cost utility of community screening for glaucoma in urban India.

    Science.gov (United States)

    John, Denny; Parikh, Rajul

    2017-07-01

    Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding

  5. Is aggressive treatment of traumatic brain injury cost-effective?

    Science.gov (United States)

    Whitmore, Robert G; Thawani, Jayesh P; Grady, M Sean; Levine, Joshua M; Sanborn, Matthew R; Stein, Sherman C

    2012-05-01

    The object of this study was to determine whether aggressive treatment of severe traumatic brain injury (TBI), including invasive intracranial monitoring and decompressive craniectomy, is cost-effective. A decision-analytical model was created to compare costs, outcomes, and cost-effectiveness of 3 strategies for treating a patient with severe TBI. The aggressive-care approach is compared with "routine care," in which Brain Trauma Foundation guidelines are not followed. A "comfort care" category, in which a single day in the ICU is followed by routine floor care, is included for comparison only. Probabilities of each treatment resulting in various Glasgow Outcome Scale (GOS) scores were obtained from the literature. The GOS scores were converted to quality-adjusted life years (QALYs), based on expected longevity and calculated quality of life associated with each GOS category. Estimated direct (acute and long-term medical care) and indirect (loss of productivity) costs were calculated from the perspective of society. Sensitivity analyses employed a 2D Monte Carlo simulation of 1000 trials, each with 1000 patients. The model was also used to estimate these values for patients 40, 60, and 80 years of age. For the average 20-year-old, aggressive care yields 11.7 (± 1.6 [SD]) QALYs, compared with routine care (10.0 ± 1.5 QALYs). This difference is highly significant (p care remains significantly better at all ages. When all costs are considered, aggressive care is also significantly less costly than routine care ($1,264,000 ± $118,000 vs $1,361,000 ± $107,000) for the average 20-year-old. Aggressive care remains significantly less costly until age 80, at which age it costs more than routine care. However, even in the 80-year-old, aggressive care is likely the more cost-effective approach. Comfort care is associated with poorer outcomes at all ages and with higher costs for all groups except 80-year-olds. When all the costs of severe TBI are considered, aggressive

  6. Costs and cost-effectiveness of family CBT versus individual CBT in clinically anxious children

    NARCIS (Netherlands)

    Bodden, D.H.M.; Dirksen, C.D.; Bögels, S.M.; Nauta, M.H.; de Haan, E.; Ringrose, J.; Appelboom, C.; Brinkman, A.G.; Appelboom-Geerts, K.C.M.M.J.

    2008-01-01

    The objective of this study was to investigate the cost-effectiveness of family cognitive-behavioral therapy (CBT) compared with individual CBT in children with anxiety disorders. Clinically anxious children (aged 8—18 years) referred for treatment were randomly assigned to family or individual CBT

  7. Should Cost-Effectiveness Analysis Include the Cost of Consumption Activities? AN Empirical Investigation.

    Science.gov (United States)

    Adarkwah, Charles Christian; Sadoghi, Amirhossein; Gandjour, Afschin

    2016-02-01

    There has been a debate on whether cost-effectiveness analysis should consider the cost of consumption and leisure time activities when using the quality-adjusted life year as a measure of health outcome under a societal perspective. The purpose of this study was to investigate whether the effects of ill health on consumptive activities are spontaneously considered in a health state valuation exercise and how much this matters. The survey enrolled patients with inflammatory bowel disease in Germany (n = 104). Patients were randomized to explicit and no explicit instruction for the consideration of consumption and leisure effects in a time trade-off (TTO) exercise. Explicit instruction to consider non-health-related utility in TTO exercises did not influence TTO scores. However, spontaneous consideration of non-health-related utility in patients without explicit instruction (60% of respondents) led to significantly lower TTO scores. Results suggest an inclusion of consumption costs in the numerator of the cost-effectiveness ratio, at least for those respondents who spontaneously consider non-health-related utility from treatment. Results also suggest that exercises eliciting health valuations from the general public may include a description of the impact of disease on consumptive activities. Copyright © 2015 John Wiley & Sons, Ltd.

  8. A systematic review of the cost and cost-effectiveness of electronic discharge communications.

    Science.gov (United States)

    Sevick, Laura K; Esmail, Rosmin; Tang, Karen; Lorenzetti, Diane L; Ronksley, Paul; James, Matthew; Santana, Maria; Ghali, William A; Clement, Fiona

    2017-07-02

    The transition between acute care and community care can be a vulnerable period in a patients' treatment due to the potential for postdischarge adverse events. The vulnerability of this period has been attributed to factors related to the miscommunication between hospital-based and community-based physicians. Electronic discharge communication has been proposed as one solution to bridge this communication gap. Prior to widespread implementation of these tools, the costs and benefits should be considered. To establish the cost and cost-effectiveness of electronic discharge communications compared with traditional discharge systems for individuals who have completed care with one provider and are transitioning care to a new provider. We conducted a systematic review of the published literature, using best practices, to identify economic evaluations/cost analyses of electronic discharge communication tools. Inclusion criteria were: (1) economic analysis and (2) electronic discharge communication tool as the intervention. Quality of each article was assessed, and data were summarised using a component-based analysis. One thousand unique abstracts were identified, and 57 full-text articles were assessed for eligibility. Four studies met final inclusion criteria. These studies varied in their primary objectives, methodology, costs reported and outcomes. All of the studies were of low to good quality. Three of the studies reported a cost-effectiveness measure ranging from an incremental daily cost of decreasing average discharge note completion by 1 day of $0.331 (2003 Canadian), a cost per page per discharge letter of €9.51 and a dynamic net present value of €31.1 million for a 5-year implementation of the intervention. None of the identified studies considered clinically meaningful patient or quality outcomes. Economic analyses of electronic discharge communications are scarcely reported, and with inconsistent methodology and outcomes. Further studies are needed

  9. Cost-effectiveness of improving pediatric hospital care in Nicaragua.

    Science.gov (United States)

    Broughton, Edward I; Gomez, Ivonne; Nuñez, Oscar; Wong, Yudy

    2011-11-01

    To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204). After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.

  10. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa, Canada.

    Science.gov (United States)

    Jozaghi, Ehsan; Reid, Andrew A; Andresen, Martin A; Juneau, Alexandre

    2014-08-04

    Supervised injection facilities (SIFs) are venues where people who inject drugs (PWID) have access to a clean and medically supervised environment in which they can safely inject their own illicit drugs. There is currently only one legal SIF in North America: Insite in Vancouver, British Columbia, Canada. The responses and feedback generated by the evaluations of Insite in Vancouver have been overwhelmingly positive. This study assesses whether the above mentioned facility in the Downtown Eastside of Vancouver needs to be expanded to other locations, more specifically that of Canada's capital city, Ottawa. The current study is aimed at contributing to the existing literature on health policy by conducting cost-benefit and cost-effective analyses for the opening of SIFs in Ottawa, Ontario. In particular, the costs of operating numerous SIFs in Ottawa was compared to the savings incurred; this was done after accounting for the prevention of new HIV and Hepatitis C (HCV) infections. To ensure accuracy, two distinct mathematical models and a sensitivity analysis were employed. The sensitivity analyses conducted with the models reveals the potential for SIFs in Ottawa to be a fiscally responsible harm reduction strategy for the prevention of HCV cases--when considered independently. With a baseline sharing rate of 19%, the cumulative annual cost model supported the establishment of two SIFs and the marginal annual cost model supported the establishment of a single SIF. More often, the prevention of HIV or HCV alone were not sufficient to justify the establishment cost-effectiveness; rather, only when both HIV and HCV are considered does sufficient economic support became apparent. Funded supervised injection facilities in Ottawa appear to be an efficient and effective use of financial resources in the public health domain.

  11. Cost-effectiveness analysis of rotavirus vaccination in Argentina.

    Science.gov (United States)

    Urueña, Analía; Pippo, Tomás; Betelu, María Sol; Virgilio, Federico; Hernández, Laura; Giglio, Norberto; Gentile, Ángela; Diosque, Máximo; Vizzotti, Carla

    2015-05-07

    Rotavirus is a leading cause of severe diarrhea in children under 5. In Argentina, the most affected regions are the Northeast and Northwest, where hospitalizations and deaths are more frequent. This study estimated the cost-effectiveness of adding either of the two licensed rotavirus vaccines to the routine immunization schedule. The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (Version 2.0) was used to assess health benefits, costs savings, life-years gained (LYGs), DALYs averted, and cost/DALY averted of vaccinating 10 successive cohorts, from the health care system and societal perspectives. Two doses of monovalent (RV1) rotavirus vaccine and three doses of pentavalent (RV5) rotavirus vaccine were each compared to a scenario assuming no vaccination. The price/dose was US$ 7.50 and US$ 5.15 for RV1 and RV5, respectively. We ran both a national and sub-national analysis, discounting all costs and benefits 3% annually. Our base case results were compared to a range of alternative univariate and multivariate scenarios. The number of LYGs was 5962 and 6440 for RV1 and RV5, respectively. The cost/DALY averted when compared to no vaccination from the health care system and societal perspective was: US$ 3870 and US$ 1802 for RV1, and US$ 2414 and US$ 358 for RV5, respectively. Equivalent figures for the Northeast were US$ 1470 and US$ 636 for RV1, and US$ 913 and US$ 80 for RV5. Therefore, rotavirus vaccination was more cost-effective in the Northeast compared to the whole country; and, in the Northwest, health service's costs saved outweighed the cost of introducing the vaccine. Vaccination with either vaccine compared to no vaccination was highly cost-effective based on WHO guidelines and Argentina's 2011 per capita GDP of US$ 9090. Key variables influencing results were vaccine efficacy, annual loss of efficacy, relative coverage of deaths, vaccine price, and discount rate. Compared to no

  12. Simulation of the cost-effectiveness of malaria vaccines

    Directory of Open Access Journals (Sweden)

    Tediosi Fabrizio

    2009-06-01

    Full Text Available Abstract Background A wide range of possible malaria vaccines is being considered and there is a need to identify which vaccines should be prioritized for clinical development. An important element of the information needed for this prioritization is a prediction of the cost-effectiveness of potential vaccines in the transmission settings in which they are likely to be deployed. This analysis needs to consider a range of delivery modalities to ensure that clinical development plans can be aligned with the most appropriate deployment strategies. Methods The simulations are based on a previously published individual-based stochastic model for the natural history and epidemiology of Plasmodium falciparum malaria. Three different vaccine types: pre-erythrocytic vaccines (PEV, blood stage vaccines (BSV, mosquito-stage transmission-blocking vaccines (MSTBV, and combinations of these, are considered each delivered via a range of delivery modalities (Expanded Programme of Immunization – EPI-, EPI with booster, and mass vaccination combined with EPI. The cost-effectiveness ratios presented are calculated for four health outcomes, for assumed vaccine prices of US$ 2 or US$ 10 per dose, projected over a 10-year period. Results The simulations suggest that PEV will be more cost-effective in low transmission settings, while BSV at higher transmission settings. Combinations of BSV and PEV are more efficient than PEV, especially in moderate to high transmission settings, while compared to BSV they are more cost-effective in moderate to low transmission settings. Combinations of MSTBV and PEV or PEV and BSV improve the effectiveness and the cost-effectiveness compared to PEV and BSV alone only when applied with EPI and mass vaccinations. Adding booster doses to the EPI is unlikely to be a cost-effective alternative to delivering vaccines via the EPI for any vaccine, while mass vaccination improves effectiveness, especially in low transmission settings, and is

  13. Cost effectiveness of open versus laparoscopic living-donor nephrectomy

    DEFF Research Database (Denmark)

    Hamidi, Vida; Andersen, Marit Helen; Oyen, Ole

    2009-01-01

    , and a consequent potential to increase the pool of kidney donors. However, the cost effectiveness of LLDN remains unknown. The aim of this study was to explore the health and cost consequences of replacing open-donor nephrectomy by LLDN. METHODS: Kidney donors were randomized to laparoscopic (n=63) or open surgery...... (n=59). We obtained data on operating time, personnel costs, length of stay, cost of analgesic, disposable instruments and complications, and indirect costs. Quality of life was captured before the operation and at 1, 6, and 12 months postdonation by means of short form-36. The scores were translated...... into utilities by means of Brazier's 6D algorithm. RESULTS: The cost per patient was U.S. $55,292 with laparoscopic and U.S. $29,886 with open surgery. The greatest cost difference was in costs attributed to complications (U.S. $33,162 vs. U.S. $4,573). The 1-year quality-adjusted life years (QALYs) were 0...

  14. Economics of mycotoxins: evaluating costs to society and cost-effectiveness of interventions.

    Science.gov (United States)

    2012-01-01

    The economic impacts of mycotoxins to human society can be thought of in two ways: (i) the direct market costs associated with lost trade or reduced revenues due to contaminated food or feed, and (ii) the human health losses from adverse effects associated with mycotoxin consumption. Losses related to markets occur within systems in which mycotoxins are being monitored in the food and feed supply. Food that has mycotoxin levels above a particular maximum allowable level is either rejected outright for sale or sold at a lower price for a different use. Such transactions can take place at local levels or at the level of trade among countries. Sometimes this can result in heavy economic losses for food producers, but the benefit of such monitoring systems is a lower risk of mycotoxins in the food supply. Losses related to health occur when mycotoxins are present in food at levels that can cause illness. In developed countries, such losses are often measured in terms of cost of illness; around the world, such losses are more frequently measured in terms of disability-adjusted life years (DALYs). It is also useful to assess the economics of interventions to reduce mycotoxins and their attendant health effects; the relative effectiveness of public health interventions can be assessed by estimating quality-adjusted life years (QALYs) associated with each intervention. Cost-effectiveness assessment can be conducted to compare the cost of implementing the intervention with the resulting benefits, in terms of either improved markets or improved human health. Aside from cost-effectiveness, however, it is also important to assess the technical feasibility of interventions, particularly in low-income countries, where funds and infrastructures are limited.

  15. Trait Positive Affect Buffers the Effects of Acute Stress on Skin Barrier Recovery

    Science.gov (United States)

    Robles, Theodore F.; Brooks, Kathryn P.; Pressman, Sarah D.

    2010-01-01

    Objective This study examines the role of self-reported trait positive affect (PA) on skin barrier recovery after skin disruption, and whether the role of trait PA in wound healing is consistent with the direct effects model or the stress-buffering model of PA and health. Design Sixty healthy participants (mean age 22.7 ± 3.9 years) completed a self-report measure of trait positive and negative affect, underwent a “tape-stripping” procedure that disrupts normal skin barrier function, and were randomly assigned to a Stress (Trier Social Stress Test) or No Stress (reading task) condition. Main Outcome Measures Skin barrier recovery was assessed by measuring transepidermal water loss up to 2 hr after skin disruption. Results Multilevel modeling indicated that greater trait PA was related to faster skin barrier recovery (p < .05). The effects of PA on skin barrier recovery were independent of levels of trait NA. Conclusion These findings suggest that trait PA may influence skin barrier recovery following a brief stressor. In addition, these results provide additional evidence that trait PA can positively impact objective health outcomes. PMID:19450044

  16. How does cognitive dissonance influence the sunk cost effect?

    Science.gov (United States)

    Chung, Shao-Hsi; Cheng, Kuo-Chih

    2018-01-01

    The sunk cost effect is the scenario when individuals are willing to continue to invest capital in a failing project. The purpose of this study was to explain such irrational behavior by exploring how sunk costs affect individuals' willingness to continue investing in an unfavorable project and to understand the role of cognitive dissonance on the sunk cost effect. This study used an experimental questionnaire survey on managers of firms listed on the Taiwan Stock Exchange and Over-The-Counter. The empirical results show that cognitive dissonance does not mediate the relationship between sunk costs and willingness to continue an unfavorable investment project. However, cognitive dissonance has a moderating effect, and only when the level of cognitive dissonance is high does the sunk cost have significantly positive impacts on willingness to continue on with an unfavorable investment. This study offers psychological mechanisms to explain the sunk cost effect based on the theory of cognitive dissonance, and it also provides some recommendations for corporate management.

  17. Impacts of optimum cost effective energy efficiency standards

    International Nuclear Information System (INIS)

    Brancic, A.B.; Peters, J.S.; Arch, M.

    1991-01-01

    Building Codes are increasingly required to be responsive to social and economic policy concerns. In 1990 the State of Connecticut passes An Act Concerning Global Warming, Public Act 90-219, which mandates the revision of the state building code to require that buildings and building elements be designed to provide optimum cost-effective energy efficiency over the useful life of the building. Further, such revision must meet the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) Standard 90.1 - 1989. As the largest electric energy supplier in Connecticut, Northeast Utilities (NU) sponsored a pilot study of the cost effectiveness of alternative building code standards for commercial construction. This paper reports on this study which analyzed design and construction means, building elements, incremental construction costs, and energy savings to determine the optimum cost-effective building code standard. Findings are that ASHRAE 90.1 results in 21% energy savings and alternative standards above it result in significant additional savings. Benefit/cost analysis showed that both are cost effective

  18. Cost-effectiveness criteria for marine oil spill preventive measures

    International Nuclear Information System (INIS)

    Vanem, Erik; Endresen, Oyvind; Skjong, Rolf

    2008-01-01

    Oil tanker accidents resulting in large quantities of oil spills and severe pollution have occurred in the past, leading to major public attention and an international focus on finding solutions for minimising the risks related to such events. This paper proposes a novel approach for evaluating measures for prevention and control of marine oil spills, based on considerations of oil spill risk and cost effectiveness. A cost model that incorporates all costs of a shipping accident has been established and oil tanker spill accidents have been further elaborated as a special case of such accidents. Utilising this model, novel implementation criteria, in terms of the Cost of Averting a Tonne of oil Spilt (CATS), for risk control options aiming at mitigating the environmental risk of accidental oil spills, are proposed. The paper presents a review of previous studies on the costs associated with oil spills from shipping, which is a function of many factors such as location of spill, spill amount, type of oil, etc. However, ships are designed for global trade, transporting different oil qualities. Therefore, globally applicable criteria must average over most of these factors, and the spill amount is the remaining factor that will be used to measure cost effectiveness against. A weighted, global average cleanup cost of USD 16,000/tonne of oil spilt has been calculated, considering the distribution of oil tanker traffic densities. Finally, the criteria are compared with some existing regulations for oil spill prevention, response and compensation (OPA 90)

  19. Effects of slim holes on hydrothermal exploration costs

    International Nuclear Information System (INIS)

    Entingh, D.; Petty, S.

    1992-01-01

    This paper estimates hydrothermal exploration costs and the effects that using slim holes could have on those costs using a computer code developed for the US-DOE. The primary goal of exploration is to generate decision driving information about particular geothermal reservoirs. Compared to today's exploration strategies, the main effect of using slim holes would be to reduce the cost of exploration by about 40 percent. Slim hole exploration does not reduce the overall cost of electricity by much; however, the cost burden is shifted later in the project when outside financing is more likely. The reduced costs of slim holes may also encourage developers to drill more holes that better characterize the reservoir, thus reducing long term reservoir risk. The cost of power could then be cut as much as six percent and project financial risks related to reservoir uncertainties could be reduced by up to one quarter. In order to realize these improvements, the amount of reservoir information recovered from small diameter bore holes needs to be significantly increased

  20. Cost-effectiveness assessment in outpatient sinonasal surgery.

    Science.gov (United States)

    Mortuaire, G; Theis, D; Fackeure, R; Chevalier, D; Gengler, I

    2018-02-01

    To assess the cost-effectiveness of outpatient sinonasal surgery in terms of clinical efficacy and control of expenses. A retrospective study was conducted from January 2014 to January 2016. Patients scheduled for outpatient sinonasal surgery were systematically included. Clinical data were extracted from surgical and anesthesiology computer files. The cost accounting methods applied in our institution were used to evaluate logistic and technical costs. The standardized hospital fees rating system based on hospital stay and severity in diagnosis-related groups (Groupes homogènes de séjours: GHS) was used to estimate institutional revenue. Over 2years, 927 outpatient surgical procedures were performed. The crossover rate to conventional hospital admission was 2.9%. In a day-1 telephone interview, 85% of patients were very satisfied with the procedure. All outpatient cases showed significantly lower costs than estimated for conventional management with overnight admission, while hospital revenue did not differ between the two. This study confirmed the efficacy of outpatient surgery in this indication. Lower costs could allow savings for the health system by readjusting the rating for the procedure. More precise assessment of cost-effectiveness will require more fine-grained studies based on micro costing at hospital level and assessment of impact on conventional surgical activity and post-discharge community care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. Cost-Effectiveness of a Clinical Childhood Obesity Intervention.

    Science.gov (United States)

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

    2017-11-01

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

  2. City-scale analysis of water-related energy identifies more cost-effective solutions.

    Science.gov (United States)

    Lam, Ka Leung; Kenway, Steven J; Lant, Paul A

    2017-02-01

    Energy and greenhouse gas management in urban water systems typically focus on optimising within the direct system boundary of water utilities that covers the centralised water supply and wastewater treatment systems, despite a greater energy influence by the water end use. This work develops a cost curve of water-related energy management options from a city perspective for a hypothetical Australian city. It is compared with that from the water utility perspective. The curves are based on 18 water-related energy management options that have been implemented or evaluated in Australia. In the studied scenario, the cost-effective energy saving potential from a city perspective (292 GWh/year) is far more significant than that from a utility perspective (65 GWh/year). In some cases, for similar capital cost, if regional water planners invested in end use options instead of utility options, a greater energy saving potential at a greater cost-effectiveness could be achieved in urban water systems. For example, upgrading a wastewater treatment plant for biogas recovery at a capital cost of $27.2 million would save 31 GWh/year with a marginal cost saving of $63/MWh, while solar hot water system rebates at a cost of $28.6 million would save 67 GWh/year with a marginal cost saving of $111/MWh. Options related to hot water use such as water-efficient shower heads, water-efficient clothes washers and solar hot water system rebates are among the most cost-effective city-scale opportunities. This study demonstrates the use of cost curves to compare both utility and end use options in a consistent framework. It also illustrates that focusing solely on managing the energy use within the utility would miss substantial non-utility water-related energy saving opportunities. There is a need to broaden the conventional scope of cost curve analysis to include water-related energy and greenhouse gas at the water end use, and to value their management from a city perspective. This

  3. Cost-effectiveness of Intensive Blood Pressure Management

    DEFF Research Database (Denmark)

    Richman, Ilana B; Fairley, Michael; Jørgensen, Mads Emil

    2016-01-01

    Importance: Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events......-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age...... and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times...

  4. The business value and cost-effectiveness of genomic medicine.

    Science.gov (United States)

    Crawford, James M; Aspinall, Mara G

    2012-05-01

    Genomic medicine offers the promise of more effective diagnosis and treatment of human diseases. Genome sequencing early in the course of disease may enable more timely and informed intervention, with reduced healthcare costs and improved long-term outcomes. However, genomic medicine strains current models for demonstrating value, challenging efforts to achieve fair payment for services delivered, both for laboratory diagnostics and for use of molecular information in clinical management. Current models of healthcare reform stipulate that care must be delivered at equal or lower cost, with better patient and population outcomes. To achieve demonstrated value, genomic medicine must overcome many uncertainties: the clinical relevance of genomic variation; potential variation in technical performance and/or computational analysis; management of massive information sets; and must have available clinical interventions that can be informed by genomic analysis, so as to attain more favorable cost management of healthcare delivery and demonstrate improvements in cost-effectiveness.

  5. Cost-effective climate policy in a small country

    International Nuclear Information System (INIS)

    Hagem, C.

    1994-01-01

    Unilateral action to curb CO 2 emissions in a small country or a group of countries has only a limited effect on global CO 2 emissions. However, it could be a first step toward a broader climate treaty. So far, unilateral commitments have been aimed at reducing national consumption of fossil fuels. A country that produces and consumes fossil fuels can also infiuence the global CO 2 emissions by reducing its production. The estimated cost of reducing national CO 2 emissions in Norway, through a reduction infossil fuel consumption, is presented in a report from the Environmental Tax Committee (1992). In this paper, that cost is compared with an estimated cost of reducing fossil fuel production. The calculation reveals that it could be less costly to reduce the production than the consumption, given that the effect on global CO 2 emissions is identical. 23 refs., 4 tabs

  6. Dynamic modeling of cost-effectiveness of rotavirus vaccination, Kazakhstan.

    Science.gov (United States)

    Freiesleben de Blasio, Birgitte; Flem, Elmira; Latipov, Renat; Kuatbaeva, Ajnagul; Kristiansen, Ivar Sønbø

    2014-01-01

    The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children vaccine cost at vaccination program costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study.

  7. Effects of payments for ecosystem services on wildlife habitat recovery.

    Science.gov (United States)

    Tuanmu, Mao-Ning; Viña, Andrés; Yang, Wu; Chen, Xiaodong; Shortridge, Ashton M; Liu, Jianguo

    2016-08-01

    Conflicts between local people's livelihoods and conservation have led to many unsuccessful conservation efforts and have stimulated debates on policies that might simultaneously promote sustainable management of protected areas and improve the living conditions of local people. Many government-sponsored payments-for-ecosystem-services (PES) schemes have been implemented around the world. However, few empirical assessments of their effectiveness have been conducted, and even fewer assessments have directly measured their effects on ecosystem services. We conducted an empirical and spatially explicit assessment of the conservation effectiveness of one of the world's largest PES programs through the use of a long-term empirical data set, a satellite-based habitat model, and spatial autoregressive analyses on direct measures of change in an ecosystem service (i.e., the provision of wildlife species habitat). Giant panda (Ailuropoda melanoleuca) habitat improved in Wolong Nature Reserve of China after the implementation of the Natural Forest Conservation Program. The improvement was more pronounced in areas monitored by local residents than those monitored by the local government, but only when a higher payment was provided. Our results suggest that the effectiveness of a PES program depends on who receives the payment and on whether the payment provides sufficient incentives. As engagement of local residents has not been incorporated in many conservation strategies elsewhere in China or around the world, our results also suggest that using an incentive-based strategy as a complement to command-and-control, community- and norm-based strategies may help achieve greater conservation effectiveness and provide a potential solution for the park versus people conflict. © 2016 Society for Conservation Biology.

  8. Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation.

    Science.gov (United States)

    Murray, A; Lourenco, T; de Verteuil, R; Hernandez, R; Fraser, C; McKinley, A; Krukowski, Z; Vale, L; Grant, A

    2006-11-01

    incorporated into a Markov model used to estimate cost-effectiveness for a time horizon of up to 25 years. In terms of incremental cost per life-year, laparoscopic surgery was found to be more costly and no more effective than open surgery. With respect to incremental cost per QALY, few data were available to differentiate between laparoscopic and open surgery. The results of the base-case analysis indicate that there is an approximately 40% chance that laparoscopic surgery is the more cost-effective intervention at a threshold willingness to pay for a QALY of pound 30,000. A second analysis assuming equal mortality and disease-free survival found that there was an approximately 50% likelihood at a similar threshold value. Broadly similar results were found in the sensitivity analyses. A threshold analysis was performed to investigate the magnitude of QALY gain associated with quicker recovery following laparoscopic surgery required to provide an incremental cost per QALY of pound 30,000. The implied number of additional QALYs required would be 0.009-0.010 compared with open surgery. Laparoscopic resection is associated with a quicker recovery (shorter time to return to usual activities and length of hospitalisation) and no evidence of a difference in mortality or disease-free survival up to 3 years following surgery. However, operation times are longer and a significant number of procedures initiated laparoscopically may need to be converted to open surgery. The rate of conversion may be dependent on experience in terms of both patient selection and performing the technique. Laparoscopic resection appears more costly to the health service than open resection, with an estimated extra total cost of between pound 250 and pound 300 per patient. In terms of relative cost-effectiveness, laparoscopic resection is associated with a modest additional cost, short-term benefits associated with more rapid recovery and similar long-term outcomes in terms of survival and cure rates up to 3

  9. Cost and Cost-Effectiveness of the Mediterranean Diet: Results of a Systematic Review

    Science.gov (United States)

    Saulle, Rosella; Semyonov, Leda; La Torre, Giuseppe

    2013-01-01

    The growing impact of chronic degenerative pathologies (such as cardiovascular disease, type 2 diabetes and Alzheimer’s disease) requires and pushes towards the development of new preventive strategies to reduce the incidence and prevalence of these diseases. Lifestyle changes, especially related to the Mediterranean diet, have the potential to modify disease outcomes and ultimately costs related to their management. The objective of the study was to perform a systematic review of the scientific literature, to gauge the economic performance and the cost-effectiveness of the adherence to the Mediterranean diet as a prevention strategy against degenerative pathologies. We investigated the monetary costs of adopting Mediterranean dietary patterns by determining cost differences between low and high adherence. Research was conducted using the PubMed and Scopus databases. Eight articles met the pre-determined inclusion criteria and were reviewed. Quality assessment and data extraction was performed. The adherence to the Mediterranean diet has been extensively reported to be associated with a favorable health outcome and a better quality of life. The implementation of a Mediterranean dietary pattern may lead to the prevention of degenerative pathologies and to an improvement in life expectancy, a net gain in health and a reduction in total lifetime costs. PMID:24253053

  10. Cost Effectiveness Analysis of Optimal Malaria Control Strategies in Kenya

    Directory of Open Access Journals (Sweden)

    Gabriel Otieno

    2016-03-01

    Full Text Available Malaria remains a leading cause of mortality and morbidity among the children under five and pregnant women in sub-Saharan Africa, but it is preventable and controllable provided current recommended interventions are properly implemented. Better utilization of malaria intervention strategies will ensure the gain for the value for money and producing health improvements in the most cost effective way. The purpose of the value for money drive is to develop a better understanding (and better articulation of costs and results so that more informed, evidence-based choices could be made. Cost effectiveness analysis is carried out to inform decision makers on how to determine where to allocate resources for malaria interventions. This study carries out cost effective analysis of one or all possible combinations of the optimal malaria control strategies (Insecticide Treated Bednets—ITNs, Treatment, Indoor Residual Spray—IRS and Intermittent Preventive Treatment for Pregnant Women—IPTp for the four different transmission settings in order to assess the extent to which the intervention strategies are beneficial and cost effective. For the four different transmission settings in Kenya the optimal solution for the 15 strategies and their associated effectiveness are computed. Cost-effective analysis using Incremental Cost Effectiveness Ratio (ICER was done after ranking the strategies in order of the increasing effectiveness (total infections averted. The findings shows that for the endemic regions the combination of ITNs, IRS, and IPTp was the most cost-effective of all the combined strategies developed in this study for malaria disease control and prevention; for the epidemic prone areas is the combination of the treatment and IRS; for seasonal areas is the use of ITNs plus treatment; and for the low risk areas is the use of treatment only. Malaria transmission in Kenya can be minimized through tailor-made intervention strategies for malaria control

  11. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Science.gov (United States)

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée JG; Polly, David W

    2016-01-01

    Background Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085). SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion Compared to traditional non-surgical treatments, SIJ fusion is a cost-effective, and, in the long term, cost-saving strategy for the treatment of SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption. PMID:26719717

  12. Emission Control Cost-Effectiveness of Alternative-Fuel Vehicles

    OpenAIRE

    Wang, Quanlu; Sperling, Daniel; Olmstead, Janis

    1993-01-01

    Although various legislation and regulations have been adopted to promote the use of alternative-fuel vehicles for curbing urban air pollution problems, there is a lack of systematic comparisons of emission control cost-effectiveness among various alternative-fuel vehicle types. In this paper, life-cycle emission reductions and life-cycle costs were estimated for passenger cars fueled with methanol, ethanol, liquified petroleum gas, compressed natural gas, and electricity. Vehicle emission es...

  13. Effects of commercially available pneumatic compression on muscle glycogen recovery after exercise.

    Science.gov (United States)

    Keck, Nathan A; Cuddy, John S; Hailes, Walter S; Dumke, Charles L; Ruby, Brent C

    2015-02-01

    The purpose of this study was to investigate the effects of pneumatic compression pants on postexercise glycogen resynthesis. Active male subjects (n = 10) completed 2 trials consisting of a 90-minute glycogen depleting ride, followed by 4 hours of recovery with either a pneumatic compression device (PCD) or passive recovery (PR) in a random counterbalanced order. A carbohydrate beverage (1.8 g·kg bodyweight) was provided at 0 and 2 hours after exercise. Muscle biopsies (vastus lateralis) were obtained immediately and 4 hours after exercise for glycogen analyses. Blood samples were collected throughout recovery to measure glucose and insulin. Eight fingerstick blood samples for lactate were collected in the last 20 minutes of the exercise period and during the initial portion of the recovery period. Heart rate was monitored throughout the trial. During the PCD trial, subjects recovered using a commercially available recovery device (NormaTec PCD) operational at 0-60 and 120-180 minutes into recovery period. The same PCD was worn during the PR trial but was not turned on to create pulsatile pressures. There was no difference in muscle glycogen resynthesis during the recovery period (6.9 ± 0.8 and 6.9 ± 0.5 mmol·kg wet wt·h for the PR and PCD trials, respectively). Blood glucose, insulin, and lactate concentrations changed with respect to time but were not different between trials (p > 0.05). The use of PCD did not alter the rate of muscle glycogen resynthesis, blood lactate, or blood glucose and insulin concentrations associated with a postexercise oral glucose load.

  14. Biological effects of petroleum hydrocarbons: Predictions of long-term effects and recovery

    International Nuclear Information System (INIS)

    Capuzzo, J.M.

    1990-01-01

    Biological effects of petroleum hydrocarbons on marine organisms and ecosystems are dependent on the persistence and bioavailability of specific hydrocarbons, the ability of organisms to accumulate and metabolize various hydrocarbons, the fate of metabolized products, and the interference of specific hydrocarbons with normal metabolic processes that may alter an organism's chances for survival and reproduction in the environment. In considering the long-term effects of petroleum hydrocarbons on marine ecosystems it is important to ascertain what biological effects may result in subtle ecological changes, changes in community structure and function, and possible impairment of fisheries resources. It is also important to understand which hydrocarbons persist in benthic environments and the sublethal effects that lead to reduced growth, delayed development and reduced reproductive effort, population decline and the loss of that population's function in marine communities. Only through a multi-disciplinary approach to the study of the fate, transport and effects of petroleum hydrocarbons on marine ecosystems will there be a significant improvement in the ability to predict the long-term effects of oil spills and to elucidate the mechanisms of recovery

  15. Chemical cocktails in aquatic systems: Pesticide effects on the response and recovery of >20 animal taxa

    International Nuclear Information System (INIS)

    Hua, Jessica; Relyea, Rick

    2014-01-01

    Natural systems are often exposed to individual insecticides or combinations of multiple insecticides. Using an additive and substitutive design, we examined how populations and communities containing >20 animal taxa are affected by four insecticides applied individually and as a mixture for 18 wks in aquatic mesocosms. The four insecticides had distinct lethal effects on the response and recovery of cladocerans, copepods, amphipods, isopods, and amphibians but not snails. The lethal effect on cladocerans and copepods induced trophic cascades that facilitated algal blooms and abiotic changes (higher pH and dissolved oxygen, but lower light transmission). Exposure to endosulfan resulted in a lag effect reducing cladocerans and spring-breeding amphibian abundance. The reduction in spring-breeding amphibian abundance led to cascading indirect effects on summer-breeding amphibians. Finally, the mixture treatment had lethal effects throughout the community that led to long-term effects on amphibian mass and unique indirect consequences on phytoplankton and abiotic variables. - Highlights: • Insecticides had unique direct and indirect effects on response and recovery. • Due to lag effects, endosulfan was more toxic than expected based on 4d tests. • Variation in oviposition phenology led to positive effects on amphibians. • Lethal direct effects of mixtures were pervasive and led to unique indirect effects. - Insecticides applied individually and in a mixture have complex direct and indirect consequences on aquatic system response and recovery

  16. Cost-Effectiveness of Secondary Screening Modalities for Hypertension

    Science.gov (United States)

    Wang, Y. Claire; Koval, Alisa M.; Nakamura, Miyabi; Newman, Jonathan D.; Schwartz, Joseph E.; Stone, Patricia W.

    2014-01-01

    Background Clinic-based blood pressure (CBP) has been the default approach for diagnosing hypertension, but patients may be misclassified due to masked hypertension (false negative) or “white coat” hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. Method We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM into routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). Results We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost-saving for diagnostic confirmation following an elevated CBP in 6 studies. Three of 4 studies found that adding HBPM to an elevated CBP was also cost-effective. Conclusion Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM following an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension. PMID:23263535

  17. Cost-effectiveness of secondary screening modalities for hypertension.

    Science.gov (United States)

    Wang, Y Claire; Koval, Alisa M; Nakamura, Miyabi; Newman, Jonathan D; Schwartz, Joseph E; Stone, Patricia W

    2013-02-01

    Clinic-based blood pressure (CBP) has been the default approach for the diagnosis of hypertension, but patients may be misclassified because of masked hypertension (false negative) or 'white coat' hypertension (false positive). The incorporation of other diagnostic modalities, such as home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), holds promise to improve diagnostic accuracy and subsequent treatment decisions. We reviewed the literature on the costs and cost-effectiveness of adding HBPM and ABPM to routine blood pressure screening in adults. We excluded letters, editorials, and studies of pregnant and/or pre-eclamptic patients, children, and patients with specific conditions (e.g. diabetes). We identified 14 original, English language studies that included cost outcomes and compared two or more modalities. ABPM was found to be cost saving for diagnostic confirmation following an elevated CBP in six studies. Three of four studies found that adding HBPM to an elevated CBP was also cost-effective. Existing evidence supports the cost-effectiveness of incorporating HBPM or ABPM after an initial CBP-based diagnosis of hypertension. Future research should focus on their implementation in clinical practice, long-term economic values, and potential roles in identifying masked hypertension.

  18. The effect of business characteristics on tax compliance costs

    Directory of Open Access Journals (Sweden)

    Popi Fauziati

    2018-05-01

    Full Text Available Compliance fee is the cost incurred by the taxpayers in fulfilling the taxation requirements imposed on the taxpayers by the law and the authority of the country. The company expects to incur the minimum tax costs associated with fulfilling its tax obligations. Research on the influence of business characteristics to tax compliance cost is still scanty. This research examined the effect of business characteristics (age, size, sector and risk management on tax compliance costs. The research design adopted in this study is survey design. The questionnaires were distributed to the members of De-partment of Cooperatives and Micro Small-Medium Enterprises in Padang City. The non-probability sampling was used as the sampling method and 92 respondents participated in this re-search. The data obtained were analyzed using Statistical Package for Social Sciences (SPSS. The research findings indicate that age, size and sector have no effect on tax compliance costs while risk management has an effect on tax compliance costs.

  19. A Cost-Effectiveness Analysis Model for Evaluating and Planning Secondary Vocational Programs

    Science.gov (United States)

    Kim, Jin Eun

    1977-01-01

    This paper conceptualizes a cost-effectiveness analysis and describes a cost-effectiveness analysis model for secondary vocational programs. It generates three kinds of cost-effectiveness measures: program effectiveness, cost efficiency, and cost-effectiveness and/or performance ratio. (Author)

  20. Cost-effectiveness and pricing of antibacterial drugs.

    Science.gov (United States)

    Verhoef, Talitha I; Morris, Stephen

    2015-01-01

    Growing resistance to antibacterial agents has increased the need for the development of new drugs to treat bacterial infections. Given increasing pressure on limited health budgets, it is important to study the cost-effectiveness of these drugs, as well as their safety and efficacy, to find out whether or not they provide value for money and should be reimbursed. In this article, we systematically reviewed 38 cost-effectiveness analyses of new antibacterial agents. Most studies showed the new antibacterial drugs were cost-effective compared to older generation drugs. Drug pricing is a complicated process, involving different stakeholders, and has a large influence on cost-effectiveness. Value-based pricing is a method to determine the price of a drug at which it can be cost-effective. It is currently unclear what the influence of value-based pricing will be on the prices of new antibacterial agents, but an important factor will be the definition of 'value', which as well as the impact of the drug on patient health might also include other factors such as wider social impact and the health impact of disease. © 2015 The Authors. Chemical Biology & Drug Design Published by John Wiley & Sons Ltd.

  1. Effect of carbohydrate supplementation on plasma glutamine during prolonged exercise and recovery

    DEFF Research Database (Denmark)

    Van Hall, Gerrit; Saris, W H; Wagenmakers, A J

    1998-01-01

    . Eight well-trained subjects cycled at an alternating workload of 50 and 80% Wmax until exhaustion (59 to 140 min). During the exercise bout the subjects received either water (control) or a carbohydrate (CHO) drink (83 g CHO x l(-1), 2 ml x kg(-1) per kg body weight every 15 min). Plasma glutamine......%) decreased below the pre-exercise level. The plasma alanine and the total amino acid concentration was still suppressed after 7 h of recovery. In conclusion, carbohydrate supplementation had neither an effect during exercise nor during recovery on the concentration of plasma glutamine or other amino acids...

  2. Cost-effectiveness of hip protectors in frail institutionalized elderly

    NARCIS (Netherlands)

    van Schoor, N.M.; de Bruyne, M.C.; van der Roer, N.; Lommerse, E.; van Tulder, M.; Bouter, L.M.; Lips, P.T.A.M.

    2004-01-01

    A randomized controlled trial was performed to examine the cost-effectiveness of external hip protectors in the prevention of hip fractures. Since the hip protectors were not effective in preventing hip fractures in our study, the main objective became to examine whether the use of hip protectors

  3. The Production Effect: Costs and Benefits in Free Recall

    Science.gov (United States)

    Jones, Angela C.; Pyc, Mary A.

    2014-01-01

    The production effect, the memorial benefit for information read aloud versus silently, has been touted as a simple memory improvement tool. The current experiments were designed to evaluate the relative costs and benefits of production using a free recall paradigm. Results extend beyond prior work showing a production effect only when production…

  4. External effects and social costs of road transport

    NARCIS (Netherlands)

    Verhoef, E.T.

    1994-01-01

    The article contains a welfare economic analysis of road transport's external effects. First, we discuss the definition of external effects. Applying this definition, it is concluded that road transport activities give rise to a wide range of external costs. However, there are no external benefits

  5. The effects of job satisfaction, employee commitment, workplace friendship and team culture on service recovery performance

    Directory of Open Access Journals (Sweden)

    Abednego Feehi Okoe

    2016-11-01

    Full Text Available The existing literature has called for more studies to be conducted on how human resource activities affect service recovery performance. This study therefore ascertains the effects of Job Satisfaction, employee Commitment, Workplace Friendship and Team Culture on Service Recovery Performance. The survey research design was used in this study. The participants were frontline employees from the various service sectors in Ghana. The convenience sampling was used as the sampling technique. A total of 372 responses were used in the final analysis. The scale items were adapted from the existing literature. Confirmatory factor analysis was used to assess the fit of the model. Multiple linear regression was used to test the hypotheses. The findings indicate that Job Satisfaction, Employee Commitment, Workplace Friendship and Team Culture significantly exerts positive influence on Service Recovery Performance of frontline employees. The findings from the study imply that there are several antecedents to Service Recovery Performance. Team Culture, Workplace Commitment, and Employee Commitment can influence Job Satisfaction which in turn will affect Service Recovery Performance resulting in customer satisfaction and retention.

  6. An investigation into the effects of the froth phase on the recovery of coal by flotation

    Energy Technology Data Exchange (ETDEWEB)

    Crawshaw, S A.M. [University of Nottingham, Nottingham (UK). Department of Mining Engineering

    1989-11-01

    The project aimed to investigate the effects of frother type and concentration on the recovery of coal by flotation, to study froth structure by photographic and image analysis techniques, and to use the information obtained in various modelling techniques to simulate the process of coal flotation. 221 refs., 136 figs., 6 apps.

  7. Dose-Response Effects of Exercise Duration and Recovery on Cognitive Functioning.

    Science.gov (United States)

    Crush, Elizabeth A; Loprinzi, Paul D

    2017-12-01

    We examined the effects of different acute exercise durations and recovery periods on cognitive function in a counterbalanced, cross-over randomized controlled experiment. We placed 352 participants, aged 18 to 35 years into one of 16 experimental groups. Each participant visited the laboratory twice, separated by a 1-week washout period. Either Visit 1 or 2 consisted of an acute bout of moderate-intensity treadmill exercise (10, 20, 30, 45, or 60 minutes) followed by a period of rest (5, 15, or 30 minutes) before taking a set of five cognitive tests; the other visit consisted only of completing the cognitive tests (no exercise). Cognitive tests sampled multiple cognitive parameters, including reasoning, concentration, memory, attention, and planning. We found that a short recovery period (i.e., 5 minutes) may have a less favorable effect on planning ability but may be beneficial for memory. In addition, for various exercise durations and recovery periods, a Group × Time × Resting (nonexercise) A cognitive interaction effect was observed such that for both memory and inhibitory cognitive ability, acute exercise (vs. no exercise) had an enhancement effect for those with lower resting cognitive functioning. The length of the acute exercise recovery period and resting cognitive ability most influenced the association between exercise and cognitive function.

  8. Continuation-Phase Cognitive Therapy's Effects on Remission and Recovery from Depression

    Science.gov (United States)

    Vittengl, Jeffrey R.; Clark, Lee Anna; Jarrett, Robin B.

    2009-01-01

    The authors tested the effects of continuation-phase cognitive therapy (C-CT) on remission and recovery from recurrent major depressive disorder, defined as 6 weeks and 8 months, respectively, of continuously absent or minimal symptoms. Responders to acute-phase cognitive therapy were randomized to 8 months of C-CT (n = 41) or assessment control…

  9. [Cost-Effectiveness and Cost-Utility Analyses of Antireflux Medicine].

    Science.gov (United States)

    Gockel, Ines; Lange, Undine Gabriele; Schürmann, Olaf; Jansen-Winkeln, Boris; Sibbel, Rainer; Lyros, Orestis; von Dercks, Nikolaus

    2018-04-12

    Laparoscopic antireflux surgery and medical therapy with proton pump inhibitors are gold standards of gastroesophageal reflux treatment. On account of limited resources and increasing healthcare needs and costs, in this analysis, not only optimal medical results, but also superiority in health economics of these 2 methods are evaluated. We performed an electronic literature survey in MEDLINE, PubMed, Cochrane Library, ISRCTN (International Standard Randomization Controlled Trial Number) as well as in the NHS Economic Evaluation Database, including studies published until 1/2017. Only studies considering the effect size of QALY (Quality-Adjusted Life Years) (with respect to different quality of life-scores) as primary outcome comparing laparoscopic fundoplication and medical therapy were included. Criteria of comparison were ICER (Incremental Cost-Effectiveness Ratio) and ICUR (Incremental Cost-Utility Ratio). Superiority of the respective treatment option for each publication was worked out. In total, 18 comparative studies were identified in the current literature with respect to above-mentioned search terms, qualifying for the defined inclusion criteria. Six studies were finally selected for analyses. Out of 6 publications, 3 showed superiority of laparoscopic fundoplication over long-term medical management based on current cost-effectiveness data. Limitations were related to different time intervals, levels of evidence of studies and underlying resources/costs of analyses, healthcare systems and applied quality of life instruments. Future prospective, randomized trials should examine this comparison in greater detail. Additionally, there is a large potential for further research in the health economics assessment of early diagnosis and prevention measures of reflux disease and Barrett's esophagus/carcinoma. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Cost effectiveness of drug eluting coronary artery stenting in a UK setting: cost-utility study.

    Science.gov (United States)

    Bagust, A; Grayson, A D; Palmer, N D; Perry, R A; Walley, T

    2006-01-01

    To assess the cost effectiveness of drug eluting stents (DES) compared with conventional stents for treatment of symptomatic coronary artery disease in the UK. Cost-utility analysis of audit based patient subgroups by means of a simple economic model. Tertiary care. 12 month audit data for 2884 patients receiving percutaneous coronary intervention with stenting at the Cardiothoracic Centre Liverpool between January 2000 and December 2002. Risk of repeat revascularisation within 12 months of index procedure and reduction in risk from use of DES. Economic modelling was used to estimate the cost-utility ratio and threshold price premium. Four factors were identified for patients undergoing elective surgery (n = 1951) and two for non-elective surgery (n = 933) to predict risk of repeat revascularisation within 12 months. Most patients fell within the subgroup with lowest risk (57% of the elective surgery group with 5.6% risk and 91% of the non-elective surgery group with 9.9% risk). Modelled cost-utility ratios were acceptable for only one group of high risk patients undergoing non-elective surgery (only one patient in audit data). Restricting the number of DES for each patient improved results marginally: 4% of stents could then be drug eluting on economic grounds. The threshold price premium justifying 90% substitution of conventional stents was estimated to be 112 pound sterling (212 USD, 162 pound sterling) (sirolimus stents) or 89 pound sterling (167 USD, 130 pound sterling) (paclitaxel stents). At current UK prices, DES are not cost effective compared with conventional stents except for a small minority of patients. Although the technology is clearly effective, general substitution is not justified unless the price premium falls substantially.

  11. Cost-Effectiveness of the Freeze-All Policy.

    Science.gov (United States)

    Roque, Matheus; Valle, Marcello; Guimarães, Fernando; Sampaio, Marcos; Geber, Selmo

    2015-08-01

    To evaluate the cost-effectiveness of freeze-all cycles when compared to fresh embryo transfer. This was an observational study with a cost-effectiveness analysis. The analysis consisted of 530 intracytoplasmic sperm injection (ICSI) cycles in a private center in Brazil between January 2012 and December 2013. A total of 530 intracytoplasmic sperm injection (ICSI) cycles - 351 fresh embryo transfers and 179 freeze-all cycles - with a gonadotropin-releasing hormone (GnRH) antagonist protocol and day 3 embryo transfers. The pregnancy rate was 31.1% in the fresh group and 39.7% in the freeze-all group. We performed two scenario analyses for costs. In scenario 1, we included those costs associated with the ICSI cycle (monitoring during controlled ovarian stimulation [COS], oocyte retrieval, embryo transfer, IVF laboratory, and medical costs), embryo cryopreservation of supernumerary embryos, hormone measurements during COS and endometrial priming, medication use (during COS, endometrial priming, and luteal phase support), ultrasound scan for frozen- thawed embryo transfer (FET), obstetric ultrasounds, and miscarriage. The total cost (in USD) per pregnancy was statistically lower in the freeze-all cycles (19,156.73 ± 1,732.99) when compared to the fresh cycles (23,059.72 ± 2,347.02). Even in Scenario 2, when charging all of the patients in the freeze-all group for cryopreservation (regardless of supernumerary embryos) and for FET, the fresh cycles had a statistically significant increase in treatment costs per ongoing pregnancy. The results presented in this study suggest that the freeze-all policy is a cost-effective strategy when compared to fresh embryo transfer.

  12. Effect of integrated N management on the recovery of fertilizer N by rice (Oryza sativa L.)

    International Nuclear Information System (INIS)

    Hazarika, S.; Sarkar, M.C.

    1996-01-01

    A field experiment was conducted in the kharif season of 1992 on a moderately well drained silt loam (Typic Ustochrept) to study the 15 N recovery from urea applied 60, 120 and 180 kg N/ha to flooded rice (var. Basmati-1) under various N management practices. The results revealed that green manure plus urea registered highest recovery of fertilizer N by rice. The application of coated calcium carbide along with urea reduced the N loss and increased the fertilizer N recovery by rice. Integrated use of manure and urea reduced the N loss to a considerable extent. Green manure was more efficient than farmyard manure in minimizing the loss of fertilizer N. The loss of fertilizer N increased with the increasing rate of urea application. All the sources of N were effective in influencing the N uptake and grain yield of rice but the variations among the sources were not significant. (author). 8 refs., 3 tabs

  13. No effect of fibrin sealant on drain output or functional recovery following simultaneous bilateral total knee arthroplasty

    DEFF Research Database (Denmark)

    Skovgaard, Christian; Holm, Bente; Troelsen, Anders

    2013-01-01

    Background and purpose Blood loss after total knee arthroplasty (TKA) may lead to anemia, blood transfusions, and increased total costs. Also, bleeding into the periarticular tissue may cause swelling and a reduction in quadriceps strength, thus impairing early functional recovery. In this random...... in TKA showed no benefit in reducing drain output or in facilitating early functional recovery when used with a tourniquet, tranexamic acid, and a femoral bone plug....

  14. Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions

    Science.gov (United States)

    Oppong, Raymond; Jit, Mark; Smith, Richard D; Butler, Christopher C; Melbye, Hasse; Mölstad, Sigvard; Coast, Joanna

    2013-01-01

    Background Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings. Aim To assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service. Design and setting Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden. Method Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance. Results POCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of €9391. At a willingness-to-pay threshold of €30 000 per QALY gained, there is a 70% probability of CRP being cost-effective. Conclusion POCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained. PMID:23834883

  15. The costs and effectiveness of various decontamination procedures

    International Nuclear Information System (INIS)

    Robinson, C.A.; Haywood, S.M.; Brown, J.

    1991-01-01

    Knowledge of the cost and effectiveness of decontamination techniques is necessary to optimise the implementation of this countermeasure. These factors vary depending upon the nature of the land affected. There is a great deal of data available on the cost and efficacy of specific decontamination techniques on particular surfaces, but little information for combinations of techniques in real environments. This paper describes the preliminary stages of a project, in progress at the National Radiological Protection Board (NRPB), aimed at providing this information, for inner city, residential and rural areas. The efficacies of individual decontamination processes on specific surfaces were from the available literature. The NRPB EXPURT (EXPosure from Urban Radionuclide Transfer) compartmental model was used to determine the effectiveness of a number of representative decontamination programmes; each programme represents a combination of common decontamination techniques which may be applied to the various surfaces comprising an inner-city, residential or rural environment, ie, paving, walls, roofs and soil. The effectiveness of each programme was measured in terms of the reduction in dose, or dose rate, to an individual in that environment, taking account of the building characteristics, and the occupancy of the population in these buildings. The costs of each programme were derived, based on data available in current literature on the cost of the constituent decontamination techniques. Representative cost and effectiveness data are presented and their application is discussed

  16. Priority Setting, Cost-Effectiveness, and the Affordable Care Act.

    Science.gov (United States)

    Persad, Govind

    2015-01-01

    The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions. First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality. Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy). Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

  17. Attributes of system testing which promote cost-effectiveness

    International Nuclear Information System (INIS)

    Martin, L.C.

    1975-01-01

    A brief overview of conventional EMP testing activity examines attributes of overall systems tests which promote cost-effectiveness. The general framework represents an EMP-oriented systems test as a portion of a planned program to design, produce, and field system elements. As such, all so-called system tests should play appropriate cost-effective roles in this program, and the objective here is to disclose such roles. The intrinsic worth of such tests depends not only upon placing proper values on the outcomes, but also upon the possible eventual consequences of not doing tests. A relative worth measure is required. Attributes of EMP system testing over the range of potential activity which encompasses research and development, production, field handling, verification, evaluation, and others are reviewed and examined. Thus, the relative worth, in a cost-effective sense, is provided by relating such attributes to the overall program objectives so that values can be placed on the outcomes for tradeoff purposes

  18. Above Bonneville passage and propagation cost effectiveness analysis

    International Nuclear Information System (INIS)

    Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

    1993-05-01

    We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region

  19. Bayesian cost-effectiveness analysis with the R package BCEA

    CERN Document Server

    Baio, Gianluca; Heath, Anna

    2017-01-01

    The book provides a description of the process of health economic evaluation and modelling for cost-effectiveness analysis, particularly from the perspective of a Bayesian statistical approach. Some relevant theory and introductory concepts are presented using practical examples and two running case studies. The book also describes in detail how to perform health economic evaluations using the R package BCEA (Bayesian Cost-Effectiveness Analysis). BCEA can be used to post-process the results of a Bayesian cost-effectiveness model and perform advanced analyses producing standardised and highly customisable outputs. It presents all the features of the package, including its many functions and their practical application, as well as its user-friendly web interface. The book is a valuable resource for statisticians and practitioners working in the field of health economics wanting to simplify and standardise their workflow, for example in the preparation of dossiers in support of marketing authorisation, or acade...

  20. A Layered Decision Model for Cost-Effective System Security

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Huaqiang; Alves-Foss, James; Soule, Terry; Pforsich, Hugh; Zhang, Du; Frincke, Deborah A.

    2008-10-01

    System security involves decisions in at least three areas: identification of well-defined security policies, selection of cost-effective defence strategies, and implementation of real-time defence tactics. Although choices made in each of these areas affect the others, existing decision models typically handle these three decision areas in isolation. There is no comprehensive tool that can integrate them to provide a single efficient model for safeguarding a network. In addition, there is no clear way to determine which particular combinations of defence decisions result in cost-effective solutions. To address these problems, this paper introduces a Layered Decision Model (LDM) for use in deciding how to address defence decisions based on their cost-effectiveness. To validate the LDM and illustrate how it is used, we used simulation to test model rationality and applied the LDM to the design of system security for an e-commercial business case.

  1. Above Bonneville Passage and Propagation Cost Effectiveness Analysis.

    Energy Technology Data Exchange (ETDEWEB)

    Paulsen, C.M.; Hyman, J.B.; Wernstedt, K.

    1993-05-01

    We have developed several models to evaluate the cost-effectiveness of alternative strategies to mitigate hydrosystem impacts on salmon and steelhead, and applied these models to areas of the Columbia River Basin. Our latest application evaluates the cost-effectiveness of proposed strategies that target mainstem survival (e.g., predator control, increases in water velocity) and subbasin propagation (e.g., habitat improvements, screening, hatchery production increases) for chinook salmon and steelhead stocks, in the portion of the Columbia Basin bounded by Bonneville, Chief Joseph, Dworshak, and Hells Canyon darns. At its core the analysis primarily considers financial cost and biological effectiveness, but we have included other attributes which may be of concern to the region.

  2. Cost-effectiveness of pharmacotherapy to reduce obesity.

    Directory of Open Access Journals (Sweden)

    J Lennert Veerman

    Full Text Available AIMS: Obesity causes a high disease burden in Australia and across the world. We aimed to analyse the cost-effectiveness of weight reduction with pharmacotherapy in Australia, and to assess its potential to reduce the disease burden due to excess body weight. METHODS: We constructed a multi-state life-table based Markov model in Excel in which body weight influences the incidence of stroke, ischemic heart disease, hypertensive heart disease, diabetes mellitus, osteoarthritis, post-menopausal breast cancer, colon cancer, endometrial cancer and kidney cancer. We use data on effectiveness identified from PubMed searches, on mortality from Australian Bureau of Statistics, on disease costs from the Australian Institute of Health and Welfare, and on drug costs from the Department of Health and Ageing. We evaluate 1-year pharmacological interventions with sibutramine and orlistat targeting obese Australian adults free of obesity-related disease. We use a lifetime horizon for costs and health outcomes and a health sector perspective for costs. Incremental Cost-Effectiveness Ratios (ICERs below A$50 000 per Disability Adjusted Life Year (DALY averted are considered good value for money. RESULTS: The ICERs are A$130 000/DALY (95% uncertainty interval [UI] 93 000-180 000 for sibutramine and A$230 000/DALY (170 000-340 000 for orlistat. The interventions reduce the body weight-related disease burden at the population level by 0.2% and 0.1%, respectively. Modest weight loss during the interventions, rapid post-intervention weight regain and low adherence limit the health benefits. CONCLUSIONS: Treatment with sibutramine or orlistat is not cost-effective from an Australian health sector perspective and has a negligible impact on the total body weight-related disease burden.

  3. Colostomy irrigation in the elderly. Effective recovery regardless of age.

    Science.gov (United States)

    Venturini, M; Bertelli, G; Forno, G; Grandi, G; Dini, D

    1990-12-01

    One hundred forty elderly cancer outpatients with colostomy in the authors' rehabilitation department were included in an analysis of the feasibility, effectiveness, and safety of periodic irrigation of remaining colon with lukewarm tap water with the aim of regaining full continence. Sixteen patients did not have a sufficiently long remaining bowel (cecostomy, transverse colostomy) and 17 were considered unsuitable to learn the technique because of advanced neoplastic disease with poor life expectancy, intercurrent disease, or stomal problems. One hundred seven patients were proposed to perform the irrigation: 17 refused to do so with the remaining 90 able to learn the method without problems. Nearly all patients achieved full continence for at least 24 hours. Three patients refused to continue, and nine interrupted for minor complications. The median duration of irrigation in the whole group is 257 days (range, 1 to 2669 days): 32 patients have been irrigating from one to five years, and 9 patients for more than 5 years. Based on these results, we recommend irrigation as standard rehabilitative treatment for elderly patients.

  4. Cost and cost effectiveness of vaginal progesterone gel in reducing preterm birth: an economic analysis of the PREGNANT trial.

    Science.gov (United States)

    Pizzi, Laura T; Seligman, Neil S; Baxter, Jason K; Jutkowitz, Eric; Berghella, Vincenzo

    2014-05-01

    Preterm birth (PTB) is a costly public health problem in the USA. The PREGNANT trial tested the efficacy of vaginal progesterone (VP) 8 % gel in reducing the likelihood of PTB among women with a short cervix. We calculated the costs and cost effectiveness of VP gel versus placebo using decision analytic models informed by PREGNANT patient-level data. PREGNANT enrolled 459 pregnant women with a cervical length of 10-20 mm and randomized them to either VP 8 % gel or placebo. We used a cost model to estimate the total cost of treatment per mother and a cost-effectiveness model to estimate the cost per PTB averted with VP gel versus placebo. Patient-level trial data informed model inputs and included PTB rates in low- and high-risk women in each study group at <28 weeks gestation, 28-31, 32-36, and ≥37 weeks. Cost assumptions were based on 2010 US healthcare services reimbursements. The cost model was validated against patient-level data. Sensitivity analyses were used to test the robustness of the cost-effectiveness model. The estimated cost per mother was $US23,079 for VP gel and $US36,436 for placebo. The cost-effectiveness model showed savings of $US24,071 per PTB averted with VP gel. VP gel realized cost savings and cost effectiveness in 79 % of simulations. Based on findings from PREGNANT, VP gel was associated with cost savings and cost effectiveness compared with placebo. Future trials designed to include cost metrics are needed to better understand the value of VP.

  5. Systematic Review of the Cost and Cost-Effectiveness of Rapid Endovascular Therapy for Acute Ischemic Stroke.

    Science.gov (United States)

    Sevick, Laura K; Ghali, Sarah; Hill, Michael D; Danthurebandara, Vishva; Lorenzetti, Diane L; Noseworthy, Tom; Spackman, Eldon; Clement, Fiona

    2017-09-01

    Rapid endovascular therapy (EVT) is an emerging treatment option for acute ischemic stroke. Several economic evaluations have been published examining the cost-effectiveness of EVT, and many international bodies are currently making adoption decisions. The objective of this study was to establish the cost-effectiveness of EVT for ischemic stroke patients and to synthesize all the publicly available economic literature. A systematic review of the published literature was conducted to identify economic evaluations and cost analyses of EVT for acute ischemic stroke patients. Systematic review best practices were followed, and study quality was assessed. Four-hundred sixty-three articles were identified from electronic databases. After deduplication, abstract review, and full-text review, 17 studies were included. Seven of the studies were cost analyses, and 10 were cost-effectiveness studies. Generally, the cost analyses reported on the cost of the approach/procedure or the hospitalization costs associated with EVT. All of the cost-effectiveness studies reported a cost per quality-adjusted life year as the primary outcomes. Studies varied in regards to the costs considered, the perspective adopted, and the time horizon used. All the studies reported a cost per quality-adjusted life year of cost and cost-effectiveness of EVT. The cost analyses suggested that although EVT was associated with higher costs, it also resulted in improved patient outcomes. From the cost-effectiveness studies, EVT seems to be good value for money when a threshold of $50 000 per quality-adjusted life year gained is adopted. © 2017 American Heart Association, Inc.

  6. Cost-effectiveness of volumetric alcohol taxation in Australia.

    Science.gov (United States)

    Byrnes, Joshua M; Cobiac, Linda J; Doran, Christopher M; Vos, Theo; Shakeshaft, Anthony P

    2010-04-19

    To estimate the potential health benefits and cost savings of an alcohol tax rate that applies equally to all alcoholic beverages based on their alcohol content (volumetric tax) and to compare the cost savings with the cost of implementation. Mathematical modelling of three scenarios of volumetric alcohol taxation for the population of Australia: (i) no change in deadweight loss, (ii) no change in tax revenue, and (iii) all alcoholic beverages taxed at the same rate as spirits. Estimated change in alcohol consumption, tax revenue and health benefit. The estimated cost of changing to a volumetric tax rate is $18 million. A volumetric tax that is deadweight loss-neutral would increase the cost of beer and wine and reduce the cost of spirits, resulting in an estimated annual increase in taxation revenue of $492 million and a 2.77% reduction in annual consumption of pure alcohol. The estimated net health gain would be 21 000 disability-adjusted life-years (DALYs), with potential cost offsets of $110 million per annum. A tax revenue-neutral scenario would result in an 0.05% decrease in consumption, and a tax on all alcohol at a spirits rate would reduce consumption by 23.85% and increase revenue by $3094 million [corrected]. All volumetric tax scenarios would provide greater health benefits and cost savings to the health sector than the existing taxation system, based on current understandings of alcohol-related health effects. An equalized volumetric tax that would reduce beer and wine consumption while increasing the consumption of spirits would need to be approached with caution. Further research is required to examine whether alcohol-related health effects vary by type of alcoholic beverage independent of the amount of alcohol consumed to provide a strong evidence platform for alcohol taxation policies.

  7. Cost-effectiveness of norovirus vaccination in children in Peru.

    Science.gov (United States)

    Mirelman, Andrew J; Ballard, Sarah Blythe; Saito, Mayuko; Kosek, Margaret N; Gilman, Robert H

    2015-06-17

    With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru's routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence rates are expected to be higher. Published

  8. Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity.

    Science.gov (United States)

    Klebanoff, Matthew J; Chhatwal, Jagpreet; Nudel, Jacob D; Corey, Kathleen E; Kaplan, Lee M; Hur, Chin

    2017-02-01

    Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited. To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study. A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their initial body mass index (calculated as weight in kilograms divided by height in meters squared) over time. In the bariatric surgery strategy, patients were subjected to risks of perioperative mortality and complications as well as initial morbidity but also experienced longer-term quality-of-life improvements associated with weight loss. Cohort demographic information-of the 228 patients included, the mean (SD) age was 17 (1.6) years, the mean (range) body mass index was 53 (34-88), and 171 (75.0%) were female-surgery-related outcomes, and base case time horizon (3 years) were based on data from the Teen-Longitudinal Assessment of Bariatric Surgery study. One-way and probabilistic sensitivity analyses were performed. Quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015-year values using the Consumer Price Index), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness. After 3 years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $30 747, yielding an unfavorable ICER of $154 684 per QALY. When the clinical study results were extrapolated to 4 years, the ICER decreased to $114 078 per QALY and became cost-effective by 5 years with an ICER of $91 032 per QALY. Outcomes were robust in most 1-way and probabilistic sensitivity analyses. Bariatric surgery incurs

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

    Science.gov (United States)

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

    2017-11-07

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

  10. The Canadian Government perspective on cost-effective regulation

    Energy Technology Data Exchange (ETDEWEB)

    Martin, J K; Iwankow, C [Treasury Board of Canada Secretariat, Ottawa, ON (Canada)

    1997-12-31

    Fiscal constraint, globalization of markets, and accelerated technological change have resulted in a new focus on the cost-effectiveness of government activities and, in turn, on methods of policy evaluation. An exploration of regulatory problems, and the use of regulation as a public policy instrument, reveals a commonalty of experience in all industrialized countries. This paper provides a brief synopsis of the Government of Canada`s perspective on cost-effective regulation. To understand cost-effective regulation, this paper examines the principles of regulatory reform which underlie the current strategy of the federal government (collaborative decision-making mechanisms., methods of clear policy evaluation, and well defined lines of accountability). It discusses the nature of, and rationale for, government regulation, the reasons for regulatory reform in the economy, and the principal aims of Canadian regulatory reform and regulatory policy assessment. It does so by specifically addressing the role of cost-benefit analysis in the process of regulatory assessment - a method which involves systematically identifying, and quantifying where possible, the social benefits and costs associated with alternative public policy actions - with a particular focus on regulation which affects the Canadian nuclear industry. (author). 51 refs.

  11. Cost-effectiveness of barium enemas performed by radiographers

    International Nuclear Information System (INIS)

    Brown, Lorraine; Desai, Sharad

    2002-01-01

    AIM: To assess the cost-effectiveness of barium enemas performed by radiographers compared to those performed by consultant radiologists. METHOD: Prospective study of 200 barium enemas carried out by a senior radiographer and a consultant radiologist. The sample was a consecutive sample of adult out-patients over a 3-month period, with no exclusion. The length of time of the enema and the numbers and grades of staff involved in the procedure were recorded. This was translated into staffing costs using the appropriate pay scales. RESULTS: The barium enemas performed by the superintendent radiographer were more cost-effective than those performed by the consultant radiologist (1406 pounds for 100 radiographer-performed barium enemas compared to 1787 pounds for 100 carried out by the consultant radiologist). CONCLUSION: In terms of staffing costs, radiographers performing barium enemas not only liberates radiologist time, it is also a cost-effective method of providing an out-patient barium enema service. Brown, L. and Desai, S. (2002)

  12. The Canadian Government perspective on cost-effective regulation

    International Nuclear Information System (INIS)

    Martin, J.K.; Iwankow, C.

    1996-01-01

    Fiscal constraint, globalization of markets, and accelerated technological change have resulted in a new focus on the cost-effectiveness of government activities and, in turn, on methods of policy evaluation. An exploration of regulatory problems, and the use of regulation as a public policy instrument, reveals a commonalty of experience in all industrialized countries. This paper provides a brief synopsis of the Government of Canada's perspective on cost-effective regulation. To understand cost-effective regulation, this paper examines the principles of regulatory reform which underlie the current strategy of the federal government (collaborative decision-making mechanisms., methods of clear policy evaluation, and well defined lines of accountability). It discusses the nature of, and rationale for, government regulation, the reasons for regulatory reform in the economy, and the principal aims of Canadian regulatory reform and regulatory policy assessment. It does so by specifically addressing the role of cost-benefit analysis in the process of regulatory assessment - a method which involves systematically identifying, and quantifying where possible, the social benefits and costs associated with alternative public policy actions - with a particular focus on regulation which affects the Canadian nuclear industry. (author). 51 refs

  13. Cost-effectiveness of minimally invasive sacroiliac joint fusion.

    Science.gov (United States)

    Cher, Daniel J; Frasco, Melissa A; Arnold, Renée Jg; Polly, David W

    2016-01-01

    Sacroiliac joint (SIJ) disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. To determine the cost-effectiveness of minimally invasive SIJ fusion. Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs) at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER) dysfunction due to degenerative sacroiliitis or SIJ disruption.

  14. Chemistry of cost effective water treatment programme in HWP (Manuguru)

    International Nuclear Information System (INIS)

    Mohapatra, C.; Laxmana Prasad, K.

    2008-01-01

    In order to develop a water treatment programme following points must be kept in mind: Effectiveness to achieve desired water quality objectives; Compliance with regulatory requirements; Cost minimization; Safety; Easy operation and protection to equipments. Heavy Water Plant (Manuguru) laboratory has developed treatment programs to treat raw water and cooling water which satisfy the above requirements and has been in use for last several years successfully without any problem. These treatment programs have been given to other plants in Heavy Water Board for implementation. This paper describes the chemistry of the treatment program and cost minimization achieved. Further these treatments have helped the plant in achieving ΦZero Discharge and indirectly reduced the production cost. The chemistry parameters are monitored regularly to ascertain the effectiveness of these treatments. The areas where significant benefits derived are raw water treatment using polyelectrolyte instead of inorganic coagulant (alum), change over of regenerant of cation exchangers from hydrochloric acid to sulfuric acid and development of in-house cooling water treatment formulation. The advantages and cost effectiveness of these treatments are discussed in detail. Further these treatments helped the plant in achieving Zero discharge and indirectly reduced production cost of heavy water. The dosage of 3 ppm of polyelectrolyte can replace 90 ppm alum at turbidity level of 300 NTU of raw water which has resulted in cost saving of Rs. 15 - 20 Lakhs in a year besides other advantages. The changeover of regenerant from HCl to H 2 SO 4 will result in cost saving of at least Rs. 1.4 Crore a year along with other advantages. The change over of proprietary formulation to in-house formulation in cooling water treatment has resulted a saving about Rs. 11 Lakhs a year. To achieve the above objectives in a sustainable way the performance results are being monitored (author)

  15. A cost-effectiveness analysis of shipboard telemedicine.

    Science.gov (United States)

    Stoloff, P H; Garcia, F E; Thomason, J E; Shia, D S

    1998-01-01

    The U.S. Navy is considering the installation of telemedicine equipment on more than 300 ships. Besides improving the quality of care, benefits would arise from avoiding medical evacuations (MEDEVACs) and returning patients to work more quickly. Because telemedicine has not yet been fully implemented by the Navy, we relied on projections of anticipated savings and costs, rather than actual expenditures, to determine cost-effectiveness. To determine the demand for telemedicine and the cost-effectiveness of various technologies (telephone and fax, e-mail and Internet, video teleconferencing (VTC), teleradiology, and diagnostic instruments), as well as their bandwidth requirements. A panel of Navy medical experts with telemedicine experience reviewed a representative sample of patient visits collected over a 1-year period and estimated the man-day savings and quality-of-care enhancements that might have occurred had telemedicine technologies been available. The savings from potentially avoiding MEDEVACs was estimated from a survey of ships' medical staff. These sample estimates were then projected to the medical workload of the entire fleet. Off-the-shelf telemedicine equipment prices were combined with installation, maintenance, training, and communication costs to obtain the lifecycle costs of the technology. If telemedicine were available to the fleet, ship medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits. Telemedicine would enhance quality of care in two-thirds of these consults. Seventeen percent of the MEDEVACs would be preventable with telemedicine (representing 155,000 travel miles), with a savings of $4400 per MEDEVAC. If the ship's communication capabilities were available, e-mail and Internet and telephone and fax would be cost-effective on all ships (including small ships and submarines). Video teleconferencing would be cost-effective on large ships (aircraft carriers and amphibious) only. Teleradiology would be cost-effective

  16. Cost-effectiveness of minimally invasive sacroiliac joint fusion

    Directory of Open Access Journals (Sweden)

    Cher DJ

    2015-12-01

    Full Text Available Daniel J Cher,1 Melissa A Frasco,2 Renée JG Arnold,2,3 David W Polly4,5 1Clinical Affairs, SI-BONE, Inc., San Jose, CA, USA; 2Division of Health Economics and Outcomes Research, Quorum Consulting, Inc., San Francisco, CA, USA; 3Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 4Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA; 5Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA Background: Sacroiliac joint (SIJ disorders are common in patients with chronic lower back pain. Minimally invasive surgical options have been shown to be effective for the treatment of chronic SIJ dysfunction. Objective: To determine the cost-effectiveness of minimally invasive SIJ fusion. Methods: Data from two prospective, multicenter, clinical trials were used to inform a Markov process cost-utility model to evaluate cumulative 5-year health quality and costs after minimally invasive SIJ fusion using triangular titanium implants or non-surgical treatment. The analysis was performed from a third-party perspective. The model specifically incorporated variation in resource utilization observed in the randomized trial. Multiple one-way and probabilistic sensitivity analyses were performed. Results: SIJ fusion was associated with a gain of approximately 0.74 quality-adjusted life years (QALYs at a cost of US$13,313 per QALY gained. In multiple one-way sensitivity analyses all scenarios resulted in an incremental cost-effectiveness ratio (ICER <$26,000/QALY. Probabilistic analyses showed a high degree of certainty that the maximum ICER for SIJ fusion was less than commonly selected thresholds for acceptability (mean ICER =$13,687, 95% confidence interval $5,162–$28,085. SIJ fusion provided potential cost savings per QALY gained compared to non-surgical treatment after a treatment horizon of greater than 13 years. Conclusion: Compared to traditional non-surgical treatments

  17. Effects of chlorimuron ethyl on terrestrial and wetland plants: Levels of, and time to recovery following sublethal exposure

    International Nuclear Information System (INIS)

    Carpenter, David; Boutin, Céline; Allison, Jane E.

    2013-01-01

    Current pesticide registration guidelines call for short-term testing of plants; long-term effects on vegetative parts and reproduction remain untested. The aims of our study were to determine level of recovery and recovery times for plants exposed to the sulfonylurea herbicide chlorimuron ethyl using data collected from single species, dose–response greenhouse experiments. The nine terrestrial and eight wetland species tested showed variable levels of recovery and recovery timeframes. Many species (six terrestrial and five wetland) were vegetatively stunted at sublethal doses and were reproductively impaired. Full recovery did not occur at all doses and maximum recovery times varied from 3 to 15 weeks in this controlled environment. In a complex community, affected species may be displaced by tolerant species, through interspecific competition, before they fully recover. It is plausible that individual populations could be diminished or eliminated through reduced seedbank inputs (annuals and perennials) and asexual reproduction (perennials). - Highlights: ► Native terrestrial and wetland plants were used to assess the risks of herbicide drift. ► Vegetative and reproductive health endpoints were evaluated over time. ► Recovery rates were found to be both species and dose dependant. ► Reproductive recovery does not always equal vegetative recovery. ► Susceptible species may be displaced by resilient or resistant species. - Capsule: This study serves to bridge the gap between simplified short-term greenhouse tests and effects of herbicides on recovery of non-target plant species after sublethal exposures.

  18. Effects of whole-body cryotherapy on recovery after hamstring damaging exercise: a crossover study.

    Science.gov (United States)

    Fonda, B; Sarabon, N

    2013-10-01

    The purpose of this study was to examine the effects of whole-body cryotherapy (WBC) on biochemical, pain, and performance parameters during the 5-day recovery period after damaging exercise for hamstrings. Participants completed a bout of damaging exercise for the hamstring muscles on two separate occasions (control and experimental condition) separated by 10 weeks. During the control condition, subjects received no treatment after the damaging exercise. The experimental condition consisted of WBC everyday during the recovery period. WBC included single 3-min daily exposures to low temperatures (-140 to -19 °C) in the cryo-cabin. During the recovery period, subjects were tested for biochemical markers, perceived pain sensation, and physical performance (squat jump, counter movement jump, maximal isometric torque production, and maximally explosive isometric torque production). Majority of the observed variables showed statistically significant time effects (P < 0.05) in control group, which indicates the presence of muscle damage. Significant interaction between the control and WBC condition was evident for the rate of torque development (P < 0.05). Pain measures substantially differed between the WBC and the control condition after the exercise. Results of this study are not completely supportive of the use of WBC for recovery enhancement after strenuous training. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. The effects of low fat chocolate milk on postexercise recovery in collegiate athletes.

    Science.gov (United States)

    Spaccarotella, Kim J; Andzel, Walter D

    2011-12-01

    Spaccarotella, KJ and Andzel, WD. The effects of low fat chocolate milk on postexercise recovery in collegiate athl