WorldWideScience

Sample records for regional generalized cost

  1. Regional cost information for private timberland conversion and management.

    Science.gov (United States)

    Lucas S Bair; Ralph J. Alig

    2006-01-01

    Cost of private timber management practices in the United States are identified, and their relationship to timber production in general is highlighted. Costs across timber-producing regions and forest types are identified by forest type and timber management practices historically applied in each region. This includes cost estimates for activities such as forest...

  2. TRIUMF: Regional government offers KAON operating costs

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1992-09-15

    After a period of uncertainty, confidence in the major KAON project for the Canadian TRIUMF Laboratory in Vancouver was boosted on 28 May at a rally of about a thousand KAON supporters in downtown Vancouver when the regional government of British Columbia announced its willingness to pay part of KAON's operating costs.

  3. TRIUMF: Regional government offers KAON operating costs

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    After a period of uncertainty, confidence in the major KAON project for the Canadian TRIUMF Laboratory in Vancouver was boosted on 28 May at a rally of about a thousand KAON supporters in downtown Vancouver when the regional government of British Columbia announced its willingness to pay part of KAON's operating costs

  4. 34 CFR 76.530 - General cost principles.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false General cost principles. 76.530 Section 76.530... Be Met by the State and Its Subgrantees? Allowable Costs § 76.530 General cost principles. Both 34 CFR 74.27 and 34 CFR 80.22 reference the general cost principles that apply to grants, subgrants and...

  5. Cost of asthma in the Asia-Pacific region

    Directory of Open Access Journals (Sweden)

    C. K. W. Lai

    2006-06-01

    Full Text Available The substantial morbidity caused by asthma suggests that the disease is associated with a large economic burden. The current study analysed the burden of asthma in eight countries in the Asia-Pacific region. Responses to questions regarding resource use from a survey of people with asthma were analysed. Unit costs were obtained for each resource use element. Individual patient costs were estimated and means calculated for each country. A multivariate model was developed to identify potential predictors of resource use. Annual per-patient direct costs ranged from US$108 for Malaysia to US$1,010 for Hong Kong. When productivity costs were included, total per-patient societal costs ranged from US$184 in Vietnam to US$1,189 in Hong Kong. Urgent care costs were responsible for 18–90% of total per-patient direct costs. Overall, total per-patient direct costs were equivalent to 13% of per capita gross domestic product and 300% of per capita healthcare spending. Extremes of age, greater severity of asthma, and poorer general health status were predictive of high cost. The per-patient cost of asthma in these countries is high, particularly when seen in the context of overall per-patient healthcare spending. Strategies to improve asthma control are likely to not only improve patient outcomes, but also to decrease societal costs.

  6. 34 CFR 75.530 - General cost principles.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false General cost principles. 75.530 Section 75.530 Education Office of the Secretary, Department of Education DIRECT GRANT PROGRAMS What Conditions Must Be Met by a Grantee? Allowable Costs § 75.530 General cost principles. The general principles to be used in...

  7. Challenges from variation across regions in cost effectiveness analysis in multi-regional clinical trials

    Directory of Open Access Journals (Sweden)

    Yunbo Chu

    2016-10-01

    Full Text Available Economic evaluation in the form of cost-effectiveness analysis has become a popular means to inform decisions in healthcare. With multi-regional clinical trials in a global development program becoming a new venue for drug efficacy testing in recent decades, questions in methods for cost-effectiveness analysis in the multi-regional clinical trials setting also emerge. This paper addresses some challenges from variation across regions in cost effectiveness analysis in multi-regional clinical trials. Several discussion points are raised for further attention and a multi-regional clinical trial example is presented to illustrate the implications in industrial application. A general message is delivered to call for a depth discussion by all stakeholders to reach an agreement on a good practice in cost-effectiveness analysis in the multi-regional clinical trials. Meanwhile, we recommend an additional consideration of cost-effectiveness analysis results based on the clinical evidence from a certain homogeneous population as sensitivity or scenario analysis upon data availability.

  8. The entropic cost of quantum generalized measurements

    Science.gov (United States)

    Mancino, Luca; Sbroscia, Marco; Roccia, Emanuele; Gianani, Ilaria; Somma, Fabrizia; Mataloni, Paolo; Paternostro, Mauro; Barbieri, Marco

    2018-03-01

    Landauer's principle introduces a symmetry between computational and physical processes: erasure of information, a logically irreversible operation, must be underlain by an irreversible transformation dissipating energy. Monitoring micro- and nano-systems needs to enter into the energetic balance of their control; hence, finding the ultimate limits is instrumental to the development of future thermal machines operating at the quantum level. We report on the experimental investigation of a lower bound to the irreversible entropy associated to generalized quantum measurements on a quantum bit. We adopted a quantum photonics gate to implement a device interpolating from the weakly disturbing to the fully invasive and maximally informative regime. Our experiment prompted us to introduce a bound taking into account both the classical result of the measurement and the outcoming quantum state; unlike previous investigation, our entropic bound is based uniquely on measurable quantities. Our results highlight what insights the information-theoretic approach provides on building blocks of quantum information processors.

  9. Allocation base of general production costs as optimization of prime costs

    Directory of Open Access Journals (Sweden)

    Levytska I.O.

    2017-03-01

    Full Text Available Qualified management aimed at optimizing financial results is the key factor in today's society. Effective management decisions depend on the necessary information about the costs of production process in all its aspects – their structure, types, accounting policies of reflecting costs. General production costs, the so-called indirect costs that are not directly related to the production process, but provide its functioning in terms of supporting structural divisions and create the necessary conditions of production, play a significant role in calculating prime costs of goods (works, services. However, the accurate estimate of prime costs of goods (works, services should be determined with the value of indirect costs (in other words, general production costs, and properly determined with the base of their allocation. The choice of allocation base of general production costs is the significant moment, depending on the nature of business, which must guarantee fair distribution regarding to the largest share of direct expenses in the total structure of production costs. The study finds the essence of general production costs based on the analysis of key definitions of leading Ukrainian economists. The optimal allocation approach of general production costs is to calculate these costs as direct production costs within each subsidiary division (department separately without selecting a base as the main one to the their total amount.

  10. Regional Marginal Abatement Cost Curves for NOx

    Data.gov (United States)

    U.S. Environmental Protection Agency — Data underlying the figures included in the manuscript "Marginal abatement cost curve for NOx incorporating controls, renewable electricity, energy efficiency and...

  11. Cost accounting of radiological examinations. Cost analysis of radiological examinations of intermediate referral hospitals and general practice.

    Science.gov (United States)

    Lääperi, A L

    1996-01-01

    The purpose of this study was to analyse the cost structure of radiological procedures in the intermediary referral hospitals and general practice and to develop a cost accounting system for radiological examinations that takes into consideration all relevant cost factors and is suitable for management of radiology departments and regional planning of radiological resources. The material comprised 174,560 basic radiological examinations performed in 1991 at 5 intermediate referral hospitals and 13 public health centres in the Pirkanmaa Hospital District in Finland. All radiological departments in the hospitals were managed by a specialist in radiology. The radiology departments at the public health care centres operated on a self-referral basis by general practitioners. The data were extracted from examination lists, inventories and balance sheets; parts of the data were estimated or calculated. The radiological examinations were compiled according to the type of examination and equipment used: conventional, contrast medium, ultrasound, mammography and roentgen examinations with mobile equipment. The majority of the examinations (87%) comprised conventional radiography. For cost analysis the cost items were grouped into 5 cost factors: personnel, equipment, material, real estate and administration costs. The depreciation time used was 10 years for roentgen equipment, 5 years for ultrasound equipment and 5 to 10 years for other capital goods. An annual interest rate of 10% was applied. Standard average values based on a sample at 2 hospitals were used for the examination-specific radiologist time, radiographer time and material costs. Four cost accounting versions with varying allocation of the major cost items were designed. Two-way analysis of variance of the effect of different allocation methods on the costs and cost structure of the examination groups was performed. On the basis of the cost analysis a cost accounting program containing both monetary and

  12. Survey of Transmission Cost Allocation Methodologies for Regional Transmission Organizations

    Energy Technology Data Exchange (ETDEWEB)

    Fink, S.; Porter, K.; Mudd, C.; Rogers, J.

    2011-02-01

    The report presents transmission cost allocation methodologies for reliability transmission projects, generation interconnection, and economic transmission projects for all Regional Transmission Organizations.

  13. Cost Effective Regional Ballistic Missile Defense

    Science.gov (United States)

    2016-02-16

    deploying advanced air defense systems18, such as the Russian S-300 and S-500, and concealing them in hardened, camouflaged sites, such as extensive... Russian objections to the European Phased Adaptive Approach (EPAA) and fund homeland defense priorities.39 Furthermore, the PTSS system was also... Theatre Ballistic Missile Defence Capability Becomes Operational,” Jane’s Missiles & Rockets, 1 February 2011. 55 Joseph W. Kirschbaum, REGIONAL MISSILE

  14. Regional projections of nuclear and fossil electric power generation costs

    International Nuclear Information System (INIS)

    Smolen, G.R.; Delene, J.G.; Fuller, L.C.; Bowers, H.I.

    1983-12-01

    The total busbar electric generating costs were estimated for locations in ten regions of the United States for base load nuclear and coal-fired power plants with a startup date of January 1995. A complete data set is supplied which specifies each parameter used to obtain the comparative results. When the comparison is based on reference cost parameters, nuclear- and coal-fired generation costs are found to be very close in most regions of the country. Nuclear power is favored in the South Atlantic region where coal must be transported over long distances, while coal-fired generation is favored in the Central and North Central regions where large reserves of cheaply mineable coal exist. The reference data set reflects recent electric utility construction experience. Significantly lower nuclear capital investment costs would result if regulatory reform and improved construction practices were instituted. The electric power generation costs for base load oil- and natural gas-fired plants were also estimated. These plants were found to be noncompetitive in all regions for those scenarios most likely to develop. Generation cost sensitivity to changes in various parameters was examined at a reference location. The sensitivity parameters included capital investment costs, lead times, capacity factors, costs of money, and coal and uranium prices. In addition to the levelized lifetime costs, year-by-year cash flows and revenue requirements are presented. The report concludes with an analysis of the economic merits of recycling spent fuel in light-water reactors

  15. Robotics in general surgery: A systematic cost assessment

    OpenAIRE

    Gkegkes, Ioannis D.; Mamais, Ioannis A.; Iavazzo, Christos

    2017-01-01

    The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from...

  16. Regional comparison of nuclear and fossil electric power generation costs

    International Nuclear Information System (INIS)

    Bowers, H.I.

    1984-01-01

    Nuclear's main disadvantages are its high capital investment cost and uncertainty in schedule compared with alternatives. Nuclear plant costs continue to rise whereas coal plant investment costs are staying relative steady. Based on average experience, nuclear capital investment costs are nearly double those of coal-fired generation plants. The capital investment cost disadvantage of nuclear is balanced by its fuel cost advantages. New base load nuclear power plants were projected to be competitive with coal-fired plants in most regions of the country. Nuclear power costs wre projected to be significantly less (10% or more) than coal-fired power costs in the South Atlantic region. Coal-fired plants were projected to have a significant economic advantage over nuclear plants in the Central and North Central regions. In the remaining seven regions, the levelized cost of power from either option was projected to be within 10%. Uncertainties in future costs of materials, services, and financing affect the relative economics of the nuclear and coal options significantly. 10 figures

  17. Relative costs of transporting low-level waste according to four postulated regional-management cases

    International Nuclear Information System (INIS)

    Wilmot, E.L.; Shirley, C.G.

    1982-01-01

    Results presented in this paper show that almost any compact binding states into cooperating regions for disposal of LLW will reduce nationwide transportation costs markedly. As a corollary, the reduction of costs may reflect a two- to four-fold reduction of transportation distances with consequent reduction of risk to the public since risk generally decreases directly as transport distances decrease

  18. Hanford general employee training - A million dollar cost beneficial program

    International Nuclear Information System (INIS)

    Gardner, P.R.

    1991-02-01

    In January 1990, Westinghouse Hanford Company implemented an interactive videodisc training program entitled Hanford General Employee Training. Covering all Institute of Nuclear Power Operations general employee training objectives, training mandated by US Department of Energy orders, and training prescribed by internal Westinghouse Hanford Company policies, Hanford General Employee Training presents and manages engaging training programs individually tailored to each of the 9,000 employees. Development costs for a sophisticated program such as Hanford General Employee Training were high compared to similar costs for developing ''equivalent'' traditional training. Hardware ($500,000) and labor costs ($400,000) totaled $900,000. Annual maintenance costs, equipment plus labor, are totalling about $200,000. On the benefit side, by consolidating some 17 previous Westinghouse Hanford Company courses and more effectively managing the instructional process, Hanford General Employee Training reduced the average student training time from over 11 hours to just under 4 hours. For 9,000 employees, the computed net annual savings exceeds $1.3 million. 2 refs

  19. Regional cost differences of hospital supply in Germany

    Directory of Open Access Journals (Sweden)

    Lauterbach, Karl W.

    2005-04-01

    Full Text Available The intended adoption of a global reimbursement system for inpatient care in Germany envisions identical payments for identical treatments at different hospitals. This may lead to losses in some hospitals and may cause problems for the supply with health care facilities in the long run if there a important regional cost differences. Cost and performance data of 1112 hospitals in Germany have been analysed for regional differences in 2001: As regional categorizations we used official classification schemes based on centrality. The investigation does not support the postulation of additional payments for selected regions in Germany accounting for level cost-differences between hospitals. Confounding influence factors like ownership and hospital size seem to be more important. We recommend further investigations to evaluate regional cost-differences on the level of medical wards and using more risk-adjusted data. The examination of the individual case is necessary.

  20. Retinopathy of prematurity: the high cost of screening regional and remote infants.

    Science.gov (United States)

    Yu, Tzu-Ying; Donovan, Tim; Armfield, Nigel; Gole, Glen A

    2018-01-25

    Demand for retinopathy of prematurity (ROP) screening is increasing for infants born at rural and regional hospitals where the service is not generally available. The health system cost for screening regional/remote infants has not been reported. The objective of this study is to evaluate the cost of ROP screening at a large centralized tertiary neonatal service for infants from regional/rural hospitals. This is a retrospective study to establish the cost of transferring regional/rural infants to the Royal Brisbane and Women's Hospital for ROP screening over a 28-month period. A total of 131 infants were included in this study. Individual infant costs were calculated from analysis of clinical and administrative records. Economic cost of ROP screening for all transfers from regional/rural hospitals to Royal Brisbane and Women's Hospital. The average economic cost of ROP screening for this cohort was AUD$5110 per infant screened and the total cost was AUD$669 413. The average cost per infant screened was highest for infants from a regional centre with a population of 75 000 (AUD$14 856 per child), which was also geographically furthest from Brisbane. No infant in this cohort transferred from a regional nursery reached criteria for intervention for ROP by standard guidelines. Health system costs for ROP screening of remote infants at a centralized hospital are high. Alternative strategies using telemedicine can now be compared with centralized screening. © 2018 Royal Australian and New Zealand College of Ophthalmologists.

  1. Cost analysis of robotic versus laparoscopic general surgery procedures.

    Science.gov (United States)

    Higgins, Rana M; Frelich, Matthew J; Bosler, Matthew E; Gould, Jon C

    2017-01-01

    Robotic surgical systems have been used at a rapidly increasing rate in general surgery. Many of these procedures have been performed laparoscopically for years. In a surgical encounter, a significant portion of the total costs is associated with consumable supplies. Our hospital system has invested in a software program that can track the costs of consumable surgical supplies. We sought to determine the differences in cost of consumables with elective laparoscopic and robotic procedures for our health care organization. De-identified procedural cost and equipment utilization data were collected from the Surgical Profitability Compass Procedure Cost Manager System (The Advisory Board Company, Washington, DC) for our health care system for laparoscopic and robotic cholecystectomy, fundoplication, and inguinal hernia between the years 2013 and 2015. Outcomes were length of stay, case duration, and supply cost. Statistical analysis was performed using a t-test for continuous variables, and statistical significance was defined as p robotic procedures. Length of stay did not differ for fundoplication or cholecystectomy. Length of stay was greater for robotic inguinal hernia repair. Case duration was similar for cholecystectomy (84.3 robotic and 75.5 min laparoscopic, p = 0.08), but significantly longer for robotic fundoplication (197.2 robotic and 162.1 min laparoscopic, p = 0.01) and inguinal hernia repair (124.0 robotic and 84.4 min laparoscopic, p = ≪0.01). We found a significantly increased cost of general surgery procedures for our health care system when cases commonly performed laparoscopically are instead performed robotically. Our analysis is limited by the fact that we only included costs associated with consumable surgical supplies. The initial acquisition cost (over $1 million for robotic surgical system), depreciation, and service contract for the robotic and laparoscopic systems were not included in this analysis.

  2. General remarks. Regional revitalization in Fukushima Prefecture

    International Nuclear Information System (INIS)

    Fujita, Reiko

    2015-01-01

    With a focus on the efforts of the Atomic Energy Society of Japan for the accident of TEPCO Fukushima Daiichi Nuclear Power Station, this paper introduces the movement of decommissioning and decontamination, as well as the efforts for regional revitalization. After the accident, the Atomic Energy Society of Japan performed information collection / analysis / evaluation, held a variety of symposiums, listened to the opinions of experts and knowledgeable persons in and out of Japan, discussed the measures for the accident, and expressed its opinions. The investigation committee academically summarized a wide variety of information about the accident, and published a report. In its accident investigation report, it analyzed the underlying factors of the accident, and proposed recommendations of 50 items. It has continued for an additional contribution to complete the decommissioning project. It is disseminating accurate and easy-to-understand information as the standpoints of residents as well as a nuclear expert. It dispatches specialists to 'Decontamination Information Plaza' to continuously carry out the decontamination advisory job. As part of regional revitalization, it has been implementing a support, such as the provision of counselling and accurate information for the decision-making on the returning-home of refugees. Its contents are as follows; (1) provision of information on the decontamination situation of each site, (2) consultation about the health effects of radiation, and (3) dispatch cooperation of lecturers for education of the staff of municipalities. (A.O.)

  3. Development of regional stump-to-mill logging cost estimators

    Science.gov (United States)

    Chris B. LeDoux; John E. Baumgras

    1989-01-01

    Planning logging operations requires estimating the logging costs for the sale or tract being harvested. Decisions need to be made on equipment selection and its application to terrain. In this paper a methodology is described that has been developed and implemented to solve the problem of accurately estimating logging costs by region. The methodology blends field time...

  4. Robotics in general surgery: A systematic cost assessment.

    Science.gov (United States)

    Gkegkes, Ioannis D; Mamais, Ioannis A; Iavazzo, Christos

    2017-01-01

    The utilisation of robotic-assisted techniques is a novelty in the field of general surgery. Our intention was to examine the up to date available literature on the cost assessment of robotic surgery of diverse operations in general surgery. PubMed and Scopus databases were searched in a systematic way to retrieve the included studies in our review. Thirty-one studies were retrieved, referring on a vast range of surgical operations. The mean cost for robotic, open and laparoscopic ranged from 2539 to 57,002, 7888 to 16,851 and 1799 to 50,408 Euros, respectively. The mean operative charges ranged from 273.74 to 13,670 Euros. More specifically, for the robotic and laparoscopic gastric fundoplication, the cost ranged from 1534 to 2257 and 657 to 763 Euros, respectively. For the robotic and laparoscopic colectomy, it ranged from 3739 to 17,080 and 3109 to 33,865 Euros, respectively. For the robotic and laparoscopic cholecystectomy, ranged from 1163.75 to 1291 and from 273.74 to 1223 Euros, respectively. The mean non-operative costs ranged from 900 to 48,796 from 8347 to 8800 and from 870 to 42,055 Euros, for robotic, open and laparoscopic technique, respectively. Conversions to laparotomy were present in 34/18,620 (0.18%) cases of laparoscopic and in 22/1488 (1.5%) cases of robotic technique. Duration of surgery robotic, open and laparoscopic ranged from 54.6 to 328.7, 129 to 234, and from 50.2 to 260 min, respectively. The present evidence reveals that robotic surgery, under specific conditions, has the potential to become cost-effective. Large number of cases, presence of industry competition and multidisciplinary team utilisation are some of the factors that could make more reasonable and cost-effective the robotic-assisted technique.

  5. Generalized belief propagation on tree robust structured region graphs

    NARCIS (Netherlands)

    Gelfand, A.E.; Welling, M.; Murphy, K.; de Freitas, N.

    2012-01-01

    This paper provides some new guidance in the construction of region graphs for Generalized Belief Propagation (GBP). We connect the problem of choosing the outer regions of a LoopStructured Region Graph (SRG) to that of finding a fundamental cycle basis of the corresponding Markov network. We also

  6. Cost analysis of ground-water supplies in the North Atlantic region, 1970

    Science.gov (United States)

    Cederstrom, Dagfin John

    1973-01-01

    The cost of municipal and industrial ground water (or, more specifically, large supplies of ground water) at the wellhead in the North Atlantic Region in 1970 generally ranged from 1.5 to 5 cents per thousand gallons. Water from crystalline rocks and shale is relatively expensive. Water from sandstone is less so. Costs of water from sands and gravels in glaciated areas and from Coastal Plain sediments range from moderate to very low. In carbonate rocks costs range from low to fairly high. The cost of ground water at the wellhead is low in areas of productive aquifers, but owing to the cost of connecting pipe, costs increase significantly in multiple-well fields. In the North Atlantic Region, development of small to moderate supplies of ground water may offer favorable cost alternatives to planners, but large supplies of ground water for delivery to one point cannot generally be developed inexpensively. Well fields in the less productive aquifers may be limited by costs to 1 or 2 million gallons a day, but in the more favorable aquifers development of several tens of millions of gallons a day may be practicable and inexpensive. Cost evaluations presented cannot be applied to any one specific well or specific site because yields of wells in any one place will depend on the local geologic and hydrologic conditions; however, with such cost adjustments as may be necessary, the methodology presented should have wide applicability. Data given show the cost of water at the wellhead based on the average yield of several wells. The cost of water delivered by a well field includes costs of connecting pipe and of wells that have the yields and spacings specified. Cost of transport of water from the well field to point of consumption and possible cost of treatment are not evaluated. In the methodology employed, costs of drilling and testing, pumping equipment, engineering for the well field, amortization at 5% percent interest, maintenance, and cost of power are considered. The

  7. DEVELOPMENT AND EVALUATION OF MEASURES TO REDUCE COSTS OF REGIONAL LOANS SERVICING

    Directory of Open Access Journals (Sweden)

    Pavel Arkadyevitch Galanskiy

    2014-10-01

    Full Text Available The paper discusses major problems of current concern connected with controlling direct obligations of Russian regions (the model of debt servicing cost parameter optimization has been worked out, and their key solutions. The methods offered to analyze debts and manage them are applicable to any Russian Federation regions characterized by budget deficit and forced to cover it using borrowed funds. The important leverage found and their impacts on sub-federal debt servicing cost are also treated in the article.Objective: to identify the direction and impact degree of various parameters on the cost of sub-federal loans.Methodology: there were used general scientific methods: analysis and synthesis, comparison, generalization, systematic approach.Results: main parameters that influence the cost of sub-federal loans servicing and allow its most effective reduction have been identified.

  8. The regional costs and benefits of acid rain control

    International Nuclear Information System (INIS)

    Berkman, M.P.

    1991-01-01

    Congress recently enacted acid rain control legislation as part of the 1990 Clean Air Act Amendments following a decade-long debate among disparate regional interests. Although Congress succeeded in drafting a law acceptable to all regions, the regional costs and benefits of the legislation remain uncertain. The research presented here attempts to estimate the regional costs and benefits and the economic impacts of acid rain controls. These estimates are made using a modeling system composed of econometric, linear programming and input-output models. The econometric and linear programming components describe markets for electricity and coal. The outputs of these components including capital investment, electricity demand, and coal production are taken as exogenous inputs by a multiregional input-output model. The input-output model produces estimates of changes in final demand, gross output, and employment. The utility linear programming model also predicts sulfur dioxide emissions (an acid-rain precursor). According to model simulations, the costs of acid rain control exceed the benefits for many regions including several regions customarily thought to be the major beneficiaries of acid rain control such as New England

  9. Provision of general paediatric surgical services in a regional hospital.

    LENUS (Irish Health Repository)

    Zgraj, O

    2012-01-31

    BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.

  10. Cost of osteoporotic hip fracture in Spain per Autonomous Region.

    Science.gov (United States)

    Bartra, A; Caeiro, J-R; Mesa-Ramos, M; Etxebarría-Foronda, I; Montejo, J; Carpintero, P; Sorio-Vilela, F; Gatell, S; Canals, L

    2018-05-21

    We estimated the health resource utilization (HRU) and associated costs during the 12months after a first osteoporotic hip fracture (OHF) in six Spanish Regions. Observational, prospective study including patients ≥65years-old hospitalized due to a first OHF in: Andalusia, Catalonia, Valencian Community, Galicia, Madrid and the Basque Country. HRU related to OHF, quality of life and patient autonomy were collected, and HRU-associated costs were estimated. Four hundred and eighty-seven patients (mean age: 83.1years, 77% women) were included, with demographic characteristics that were similar across the Regions. Mean hospital stay was longest in Madrid and Galicia (women/men: 15.0/18.6 and 16.9/12.6days, respectively) and shortest in Andalusia and the Valencian Community (8.2/7.2 and 8.4/9.4days). There were more rehabilitation sessions and formal home care days in Catalonia and Madrid (women/men: 16/21 and 17/29 sessions; 19/20 and 30/27days) and fewer in Andalusia and Galicia (4/1 and 3/0 sessions; 3/1 and 1/0days). Mean HRU costs were higher in Madrid and lower in Andalusia (women/men: 12,321€/12,297€ and 7,031€/6,115€, respectively). OHF place a large burden on Spanish Regional Health Systems, including high economic costs. We found notable differences in mean costs across the Regions, mainly caused by the differential length of the first hospital stay and the outpatient care in subsequent months. These differences may be associated with differences in surgical delay. A national consensus on the management of OHF is desirable; moreover, agreeing common guidelines could have major socio-economic and healthcare benefits. Copyright © 2018 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Regional energy autarky: Potentials, costs and consequences for an Austrian region

    International Nuclear Information System (INIS)

    Schmidt, J.; Schönhart, M.; Biberacher, M.; Guggenberger, T.; Hausl, S.; Kalt, G.; Leduc, S.; Schardinger, I.; Schmid, E.

    2012-01-01

    Local actors at community level often thrive for energy autarky to decrease the dependence on imported energy resources. We assess the potentials and trade-offs between benefits and costs of increasing levels of energy autarky for a small rural region of around 21,000 inhabitants in Austria. We use a novel modeling approach which couples a regional energy system model with a regional land use optimization model. We have collected and processed data on the spatial distribution of energy demand and potentials of biomass, photovoltaics and solar thermal resources. The impacts of increasing biomass production on the agricultural sector are assessed with a land-use optimization model that allows deriving regional biomass supply curves. An energy system model is subsequently applied to find the least cost solution for supplying the region with energy resources. Model results indicate that fossil fuel use for heating can be replaced at low costs by increasing forestry and agricultural biomass production. However, autarky in the electricity and the heating sector would significantly increase biomass production and require a full use of the potentials of photovoltaics on roof tops. Attaining energy autarky implies high costs to consumers and a decline in the local production of food and feed. - Highlights: ► Energy autarky strong vision for many regional actors. ► Assessment of consequences of energy autarky for a rural region in Austria. ► Novel modeling approach coupling energy system model with land use model. ► Power and heat autarky causes high costs and decline in regional food and feed production. ► Heat autarky achievable at lower costs by utilizing regional forestry and agricultural biomass.

  12. Regional Cost Estimates for Reclamation Practices on Arid and Semiarid Lands; TOPICAL

    International Nuclear Information System (INIS)

    W. K. Ostler

    2002-01-01

    The U.S. Army uses the Integrated Training Area Management program for managing training land. One of the major objectives of the Integrated Training Area Management program has been to develop a method for estimating training land carrying capacity in a sustainable manner. The Army Training and Testing Area Carrying Capacity methodology measures training load in terms of Maneuver Impact Miles. One Maneuver Impact Mile is the equivalent impact of an M1A2 tank traveling one mile while participating in an armor battalion field training exercise. The Army Training and Testing Area Carrying Capacity methodology is also designed to predict land maintenance costs in terms of dollars per Maneuver Impact Mile. The overall cost factor is calculated using the historical cost of land maintenance practices and the effectiveness of controlling erosion. Because land maintenance costs and effectiveness are influenced by the characteristics of the land, Army Training and Testing Area Carrying Capacity cost factors must be developed for each ecological region of the country. Costs for land maintenance activities are presented here for the semiarid and arid regions of the United States. Five ecoregions are recognized, and average values for reclamation activities are presented. Because there are many variables that can influence costs, ranges for reclamation activities are also presented. Costs are broken down into six major categories: seedbed preparation, fertilization, seeding, planting, mulching, and supplemental erosion control. Costs for most land reclamation practices and materials varied widely within and between ecological provinces. Although regional cost patterns were evident for some practices, the patterns were not consistent between practices. For the purpose of estimating land reclamation costs for the Army Training and Testing Area Carrying Capacity methodology, it may be desirable to use the ''Combined Average'' of all provinces found in the last row of each table

  13. Effects of regional agglomeration of salmon : aquaculture on production costs

    OpenAIRE

    Tveterås, Ragnar

    2001-01-01

    During the last decade empirical evidence of regional agglomeration economies has emerged for some industries. This report argues that externalities from agglomeration are not only present in some manufacturing and service sectors, but can also occur in primary industries such as aquaculture. Econometric analyses in this literature have primarily estimated production functions on aggregated industry data. Here, cost functions are estimated on firm level observations of Norwegian salmon aquacu...

  14. A Poisson process approximation for generalized K-5 confidence regions

    Science.gov (United States)

    Arsham, H.; Miller, D. R.

    1982-01-01

    One-sided confidence regions for continuous cumulative distribution functions are constructed using empirical cumulative distribution functions and the generalized Kolmogorov-Smirnov distance. The band width of such regions becomes narrower in the right or left tail of the distribution. To avoid tedious computation of confidence levels and critical values, an approximation based on the Poisson process is introduced. This aproximation provides a conservative confidence region; moreover, the approximation error decreases monotonically to 0 as sample size increases. Critical values necessary for implementation are given. Applications are made to the areas of risk analysis, investment modeling, reliability assessment, and analysis of fault tolerant systems.

  15. 42 CFR 417.564 - Apportionment and allocation of administrative and general costs.

    Science.gov (United States)

    2010-10-01

    ... general costs. 417.564 Section 417.564 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... providing medical care. Enrollment, marketing, and other administrative and general costs that benefit the... benefit of which cannot be quantitatively measured (such as facility costs), the total allowable costs of...

  16. Outcrossings of safe regions by generalized hyperbolic processes

    DEFF Research Database (Denmark)

    Klüppelberg, Claudia; Rasmussen, Morten Grud

    2013-01-01

    We present a simple Gaussian mixture model in space and time with generalized hyperbolic marginals. Starting with Rice’s celebrated formula for level upcrossings and outcrossings of safe regions we investigate the consequences of the mean-variance mixture model on such quantities. We obtain...

  17. A General Model for Cost Estimation in an Exchange

    Directory of Open Access Journals (Sweden)

    Benzion Barlev

    2014-03-01

    Full Text Available Current Generally Accepted Accounting Principles (GAAP state that the cost of an asset acquired for cash is the fair value (FV of the amount surrendered, and that of an asset acquired in a non-monetary exchange is the FV of the asset surrendered or, if it is more “clearly evident,” the FV of the acquired asset. The measurement method prescribed for a non-monetary exchange ignores valuable information about the “less clearly evident” asset. Thus, we suggest that the FV in any exchange be measured by the weighted average of the exchanged assets’ FV estimations, where the weights are the inverse of the variances’ estimations. This alternative valuation process accounts for the uncertainty involved in estimating the FV of each of the asset in the exchange. The proposed method suits all types of exchanges: monetary and non-monetary. In a monetary transaction, the weighted average equals the cash paid because the variance of its FV is nil.

  18. A general approach to total repair cost limit replacement policies

    Directory of Open Access Journals (Sweden)

    F. Beichelt

    2014-01-01

    Full Text Available A common replacement policy for technical systems consists in replacing a system by a new one after its economic lifetime, i.e. at that moment when its long-run maintenance cost rate is minimal. However, the strict application of the economic lifetime does not take into account the individual deviations of maintenance cost rates of single systems from the average cost development. Hence, Beichet proposed the total repair cost limit replacement policy: the system is replaced by a new one as soon as its total repair cost reaches or exceeds a given level. He modelled the repair cost development by functions of the Wiener process with drift. Here the same policy is considered under the assumption that the one-dimensional probability distribution of the process describing the repair cost development is given. In the examples analysed, applying the total repair cost limit replacement policy instead of the economic life-time leads to cost savings of between 4% and 30%. Finally, it is illustrated how to include the reliability aspect into the policy.

  19. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector

    Directory of Open Access Journals (Sweden)

    Edejer Tessa

    2003-12-01

    Full Text Available Abstract Cost-effectiveness analysis (CEA is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. As a form of sectoral CEA, Generalized CEA sets out to overcome a number of these barriers to the appropriate use of cost-effectiveness information at the regional and country level. Its application via WHO-CHOICE provides a new economic evidence base, as well as underlying methodological developments, concerning the cost-effectiveness of a range of health interventions for leading causes of, and risk factors for, disease. The estimated sub-regional costs and effects of different interventions provided by WHO-CHOICE can readily be tailored to the specific context of individual countries, for example by adjustment to the quantity and unit prices of intervention inputs (costs or the coverage, efficacy and adherence rates of interventions (effectiveness. The potential usefulness of this information for health policy and planning is in assessing if current intervention strategies represent an efficient use of scarce resources, and which of the potential additional interventions that are not yet implemented, or not implemented fully, should be given priority on the grounds of cost-effectiveness. Health policy-makers and programme managers can use results from WHO-CHOICE as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor.

  20. Nanoparticle risk management and cost evaluation: a general framework

    Science.gov (United States)

    Fleury, Dominique; Bomfim, João A. S.; Metz, Sébastien; Bouillard, Jacques X.; Brignon, Jean-Marc

    2011-07-01

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  1. Nanoparticle risk management and cost evaluation: a general framework

    International Nuclear Information System (INIS)

    Fleury, Dominique; Metz, Sebastien; Bouillard, Jacques X; Brignon, Jean-Marc; Bomfim, Joao A S

    2011-01-01

    Industrial production of nano-objects has been growing fast during the last decade and a wide range of products containing nanoparticles (NPs) is proposed to the public in various markets (automotive, electronics, textiles...). The issues encountered in monitoring the presence of nano-objects in any media cause a major difficulty for controlling the risk associated to the production stage. It is therefore very difficult to assess the efficiency of prevention and mitigation solutions, which potentially leads to overestimate the level of the protection barriers that are recommended. The extra costs in adding nano-objects to the process, especially that of nanosafety, must be estimated and optimized to ensure the competitiveness of the future production lines and associated products. The risk management and cost evaluation methods presented herein have been designed for application in a pilot production line of injection-moulded nanocomposites.

  2. On the relation between cost and service models for general inventory systems

    NARCIS (Netherlands)

    Houtum, van G.J.J.A.N.; Zijm, W.H.M.

    2000-01-01

    In this paper, we present a systematic overview of possible relations between cost and service models for fairly general single- and multi-stage inventory systems. In particular, we relate various types of penalty costs in pure cost models to equivalent types of service measures in service models.

  3. Cooperation control strategies for China's cross-region pollution in a lake basin based on green reduction cost.

    Science.gov (United States)

    Li, Changmin; Sun, Dong; Xie, Xiaoqiang; Xue, Jian

    2016-05-01

    The cross-region water pollution issue has always been the widespread concern around the world. It becomes especially critical for China due to the imbalance relates to environmental costs that have accompanied rapid growth of economy. Though the government makes great efforts to improve it, the potential for water pollution conflict is still great. We consider the problem of determining combined control strategies for China's cross-region lake pollution based on the environmental green costs. The problem is first formulated as a generalized bilevel mathematical program where the upper level consists in each region that reduces environmental green costs including three parts: the reduction cost, pollution permit trade cost and cost of environment damage, while the lower level is represented by pollution permit equilibrium market. Finally, we take an empirical analysis in Taihu lake. The numerical study shows that the minimum costs of both total and regional are obviously superior to the current processing costs, which provides theoretical basis for the price of emission permits. Today, China's rapid gross domestic product (GDP) growth has come at a very high cost, as real estate prices have skyrocketed, the wealth gap has widened, and environmental pollution has worsened. China's central government is urged to correct the GDP-oriented performance evaluation system that is used to judge administrative region leaders. The cross-region water pollution issue has become a troubling issue that urgently needs to be resolved in China. This paper will not only actively aid efforts to govern Lake Taihu and other cross-region valleys, but it will also provide a supplement for theoretical research on cross-region pollution issues.

  4. Strategic trade between two regions with partial local consumer protection - General setup and nash equilibria

    Science.gov (United States)

    Iordanov, Iordan V.; Vassilev, Andrey A.

    2017-12-01

    We construct a model of the trade relations between two regions for the case when the trading entities (consumers) compete for a scarce good and there is an element of strategic interdependence in the trading process. Additionally, local consumers enjoy partial protection in the form of guaranteed access to a part of the locally-supplied quantity of the good. The model is formulated for the general asymmetric case, where the two regions differ in terms of parameters such as income, size of the local market supply, degree of protection and transportation costs. For this general model we establish the existence of Nash equilibria and obtain their form as a function of the model parameters, producing a typology of the equilibria. This is a required step in order to rigorously study various types of price dynamics for the model.

  5. Energy balance and cost analysis for raisin production in Aegean Region in Turkey

    Directory of Open Access Journals (Sweden)

    Uysal Hülya

    2016-01-01

    Full Text Available The aim of this study is to determine energy consumption of input and output used in raisin production and making a cost analysis in Aegean Region. Energy output-input analysis is generally done to determine the scope of environment and energy efficiency of agricultural production. In this study the cost of raisin production was calculated by Manisa Viticulture Research Institute's records in 2015. Costs of inputs and prices of raisin were obtained from various sources such as Turkish Statistical Institute, Aegean Exporters' Association and Turkish Ministry of Food, Agriculture and Livestock. The total energy input necessity for raisin production was 39,066.91 MJ/ha. The research results indicated that the total energy input used for raisin was mainly dependent on non-renewable energy forms (%97. The high ratio of non-renewable energy in the total used energy inputs causes negative effects on the sustainability in agricultural production. Among input energy sources, diesel oil, chemical fertilizers and electricity contained highest energy shares with 34.30%, 26.96%, and 22.50% respectively. The energy ratio and energy productivity were found to be 6.04 and 0.51 kg/MJ. Gross production value and total variable costs for raisin were $ 8,600 and $ 4,528.25, respectively. As a result of cost analysis, gross margin was calculated as $ 4,071.75.

  6. 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

  7. Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective.

    Science.gov (United States)

    Chandran, D; Woods, C M; Schar, M; Ma, N; Ooi, E H; Athanasiadis, T

    2018-02-01

    To conduct a cost analysis of injection laryngoplasty performed in the operating theatre under local anaesthesia and general anaesthesia. The retrospective study included patients who had undergone injection laryngoplasty as day cases between July 2013 and March 2016. Cost data were obtained, along with patient demographics, anaesthetic details, type of injectant, American Society of Anesthesiologists score, length of stay, total operating theatre time and surgeon procedure time. A total of 20 cases (general anaesthesia = 6, local anaesthesia = 14) were included in the cost analysis. The mean total cost under general anaesthesia (AU$2865.96 ± 756.29) was significantly higher than that under local anaesthesia (AU$1731.61 ± 290.29) (p costs. Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.

  8. The Stickiness of Selling, General, and Administrative Costs in the Indonesian Companies

    Directory of Open Access Journals (Sweden)

    Benny Armanto

    2014-04-01

    Full Text Available Selling, general and administration costs are the main components in the Income Statement. A large number of permanent staff in sales and marketing department will make the company dominated by the fixed costs. This fact could lead to sticky cost behavior. In addition, role of the manager can also cause the cost stickiness. When the company’s revenue decreases, manager may delay to decrease the cost or not even decrease cost at all. The objective of the study is to determine whether cost stickiness of selling, general and administrative in the Indonesian listed companies. This study applied log-linear data panel regression with 3605 firm years that is listed in Indonesian Stock Exchange (BEI from 1993 – 2013. This study finds that selling, general, and administrative costs are sticky only for the manufacturing companies. Furthermore, the results show that adjustment of sales, general, and administrative costs delayed by the manager when revenue decreases, yet the cost stickiness will be reduced in the next period.

  9. The Cost of Brain Surgery: Awake vs Asleep Craniotomy for Perirolandic Region Tumors.

    Science.gov (United States)

    Eseonu, Chikezie I; Rincon-Torroella, Jordina; ReFaey, Karim; Quiñones-Hinojosa, Alfredo

    2017-08-01

    Cost effectiveness has become an important factor in the health care system, requiring surgeons to improve efficacy of procedures while reducing costs. An awake craniotomy (AC) with direct cortical stimulation (DCS) presents one method to resect eloquent region tumors; however, some authors assert that this procedure is an expensive alternative to surgery under general anesthesia (GA) with neuromonitoring. To evaluate the cost effectiveness and clinical outcomes between AC and GA patients. Retrospective analysis of a cohort of 17 patients with perirolandic gliomas who underwent an AC with DCS were case-control matched with 23 patients with perirolandic gliomas who underwent surgery under GA with neuromonitoring (ie, motor-evoked potentials, somatosensory-evoked potentials, phase reversal). Inpatient costs, quality-adjusted life years (QALY), extent of resection, and neurological outcome were compared between the groups. Total inpatient expense per patient was $34 804 in the AC group and $46 798 in the GA group ( P = .046). QALY score for the AC group was 0.97 and 0.47 for the GA group ( P = .041). The incremental cost per QALY for the AC group was $82 720 less than the GA group. Postoperative Karnofsky performance status was 91.8 in the AC group and 81.3 in the GA group (P = .047). Length of hospitalization was 4.12 days in the AC group and 7.61 days in the GA group ( P = .049). The total inpatient costs for awake craniotomies were lower than surgery under GA. This study suggests better cost effectiveness and neurological outcome with awake craniotomies for perirolandic gliomas. Copyright © 2017 by the Congress of Neurological Surgeons

  10. Education, cost of living and regional wage inequality in Brazil

    OpenAIRE

    Luciana M.S. Servo; Carlos R. Azzoni

    2002-01-01

    The objective of this article is to analyze wage inequality among the 10 largest metropolitan regions in Brazil in the 1990s. We assess the extent to which worker characteristics (education, age, gender, race, position in the family) and job characteristics (occupational position, sector, experience) can explain wage inequality. The analysis is made both with regional-nominal and with regional-real wage data. In the second case regional price indexes are used to control for differences in cos...

  11. Predicting Cost/Reliability/Maintainability of Advanced General Aviation Avionics Equipment

    Science.gov (United States)

    Davis, M. R.; Kamins, M.; Mooz, W. E.

    1978-01-01

    A methodology is provided for assisting NASA in estimating the cost, reliability, and maintenance (CRM) requirements for general avionics equipment operating in the 1980's. Practical problems of predicting these factors are examined. The usefulness and short comings of different approaches for modeling coast and reliability estimates are discussed together with special problems caused by the lack of historical data on the cost of maintaining general aviation avionics. Suggestions are offered on how NASA might proceed in assessing cost reliability CRM implications in the absence of reliable generalized predictive models.

  12. Cost-effectiveness analysis of HPV vaccination: comparing the general population with socially vulnerable individuals.

    Science.gov (United States)

    Han, Kyu-Tae; Kim, Sun Jung; Lee, Seo Yoon; Park, Eun-Cheol

    2014-01-01

    After the WHO recommended HPV vaccination of the general population in 2009, government support of HPV vaccination programs was increased in many countries. However, this policy was not implemented in Korea due to perceived low cost-effectiveness. Thus, the aim of this study was to analyze the cost-utility of HPV vaccination programs targeted to high risk populations as compared to vaccination programs for the general population. Each study population was set to 100,000 people in a simulation study to determine the incremental cost-utility ratio (ICUR), then standard prevalence rates, cost, vaccination rates, vaccine efficacy, and the Quality-Adjusted Life-Years (QALYs) were applied to the analysis. In addition, sensitivity analysis was performed by assuming discounted vaccination cost. In the socially vulnerable population, QALYs gained through HPV vaccination were higher than that of the general population (General population: 1,019, Socially vulnerable population: 5,582). The results of ICUR showed that the cost of HPV vaccination was higher for the general population than the socially vulnerable population. (General population: 52,279,255 KRW, Socially vulnerable population: 9,547,347 KRW). Compared with 24 million KRW/QALYs as the social threshold, vaccination of the general population was not cost-effective. In contrast, vaccination of the socially vulnerable population was strongly cost-effective. The results suggest the importance and necessity of government support of HPV vaccination programs targeted to socially vulnerable populations because a targeted approach is much more cost-effective. The implementation of government support for such vaccination programs is a critical strategy for decreasing the burden of HPV infection in Korea.

  13. The Generalized Roy Model and the Cost-Benefit Analysis of Social Programs*

    Science.gov (United States)

    Eisenhauer, Philipp; Heckman, James J.; Vytlacil, Edward

    2015-01-01

    The literature on treatment effects focuses on gross benefits from program participation. We extend this literature by developing conditions under which it is possible to identify parameters measuring the cost and net surplus from program participation. Using the generalized Roy model, we nonparametrically identify the cost, benefit, and net surplus of selection into treatment without requiring the analyst to have direct information on the cost. We apply our methodology to estimate the gross benefit and net surplus of attending college. PMID:26709315

  14. The Generalized Roy Model and the Cost-Benefit Analysis of Social Programs.

    Science.gov (United States)

    Eisenhauer, Philipp; Heckman, James J; Vytlacil, Edward

    2015-04-01

    The literature on treatment effects focuses on gross benefits from program participation. We extend this literature by developing conditions under which it is possible to identify parameters measuring the cost and net surplus from program participation. Using the generalized Roy model, we nonparametrically identify the cost, benefit, and net surplus of selection into treatment without requiring the analyst to have direct information on the cost. We apply our methodology to estimate the gross benefit and net surplus of attending college.

  15. Regional Comparative Unit Cost Studies for Maintenance and Operation of Physical Plants in Universities and Colleges in Central States Region and Rocky Mountain Region.

    Science.gov (United States)

    Association of Physical Plant Administrators, Corvallis, OR.

    Presented in this document are data pertaining to maintenance and operations costs at colleges and universities in the central states region and the Rocky Mountain region. The major accounts included in the cost analysis are: (1) physical plant administration, (2) building maintenance, (3) custodial services, (4) utilities, (5) landscape and…

  16. Hospital costs associated with surgical site infections in general and vascular surgery patients.

    Science.gov (United States)

    Boltz, Melissa M; Hollenbeak, Christopher S; Julian, Kathleen G; Ortenzi, Gail; Dillon, Peter W

    2011-11-01

    Although much has been written about excess cost and duration of stay (DOS) associated with surgical site infections (SSIs) after cardiothoracic surgery, less has been reported after vascular and general surgery. We used data from the National Surgical Quality Improvement Program (NSQIP) to estimate the total cost and DOS associated with SSIs in patients undergoing general and vascular surgery. Using standard NSQIP practices, data were collected on patients undergoing general and vascular surgery at a single academic center between 2007 and 2009 and were merged with fully loaded operating costs obtained from the hospital accounting database. Logistic regression was used to determine which patient and preoperative variables influenced the occurrence of SSIs. After adjusting for patient characteristics, costs and DOS were fit to linear regression models to determine the effect of SSIs. Of the 2,250 general and vascular surgery patients sampled, SSIs were observed in 186 inpatients. Predisposing factors of SSIs were male sex, insulin-dependent diabetes, steroid use, wound classification, and operative time (P surgery. Although the excess costs and DOS associated with SSIs after general and vascular surgery are somewhat less, they still represent substantial financial and opportunity costs to hospitals and suggest, along with the implications for patient care, a continuing need for cost-effective quality improvement and programs of infection prevention. Copyright © 2011 Mosby, Inc. All rights reserved.

  17. Cost estimation for solid waste management in industrialising regions – Precedents, problems and prospects

    International Nuclear Information System (INIS)

    Parthan, Shantha R.; Milke, Mark W.; Wilson, David C.; Cocks, John H.

    2012-01-01

    Highlights: ► We review cost estimation approaches for solid waste management. ► Unit cost method and benchmarking techniques used in industrialising regions (IR). ► Variety in scope, quality and stakeholders makes cost estimation challenging in IR. ► Integrate waste flow and cost models using cost functions to improve cost planning. - Abstract: The importance of cost planning for solid waste management (SWM) in industrialising regions (IR) is not well recognised. The approaches used to estimate costs of SWM can broadly be classified into three categories – the unit cost method, benchmarking techniques and developing cost models using sub-approaches such as cost and production function analysis. These methods have been developed into computer programmes with varying functionality and utility. IR mostly use the unit cost and benchmarking approach to estimate their SWM costs. The models for cost estimation, on the other hand, are used at times in industrialised countries, but not in IR. Taken together, these approaches could be viewed as precedents that can be modified appropriately to suit waste management systems in IR. The main challenges (or problems) one might face while attempting to do so are a lack of cost data, and a lack of quality for what data do exist. There are practical benefits to planners in IR where solid waste problems are critical and budgets are limited.

  18. A generalized cost Malmquist index in DEA for DMUs with negative data

    Directory of Open Access Journals (Sweden)

    Ghasem Tohidi

    2014-10-01

    Full Text Available In some data envelopment analysis (DEA applications, some inputs of DMUs have negative values with positive cost. This paper generalizes the global cost Malmquist productivity index to compare the productivity of different DMUs with negative inputs in any two periods of times under variable returns to scale (VRS technology, and then the generalized index is decomposed to several components. The obtained components are computed using the nonparametric linear programming models, known as DEA. To illustrate the generalized index and its components, a numerical example at three successive periods of time is given.

  19. Regional differences in China's CO2 abatement cost

    International Nuclear Information System (INIS)

    He, Xiaoping

    2015-01-01

    Under a framework of output distance function with multiple outputs, the study discusses the carbon abatement cost at provincial and regional levels in China, using the shadow price analysis. The findings show that the abatement cost, reflecting the marginal opportunity cost of carbon reduction, varies greatly among the provinces. On average, the abatement cost of the eastern region was much higher than that of the mid-western region during the observed period. The findings provide evidence that the carbon prices in the current ETS pilots have been much lower than desired levels, implying inefficiency of the markets. The wide range of the abatement cost estimates supports that the equi-marginal principle does not hold for the regulations on carbon pollution at regional levels. The regional cost differences indicate the huge potential for China to minimize the total abatement cost with policy instruments that may motive the emissions moving from areas of low abatement cost to where the abatement cost is higher. For a few undeveloped provinces that are environmentally fragile and have high abatement cost, supplementary measures will be needed to reduce the negative impact of carbon cutbacks on the poor to the minimum. - Highlights: • The marginal abatement cost of CO 2 is defined by the shadow price measure. • A linear programming model based on distance function is established. • Marginal abatement costs at provincial level are empirical investigated. • The abatement cost varies across provinces and regions in China. • The findings provide evidence that the current ETS pilots are inefficient

  20. Automotive Lithium-ion Cell Manufacturing: Regional Cost Structures and Supply Chain Considerations

    Energy Technology Data Exchange (ETDEWEB)

    Donald Chung, Emma Elgqvist, and Shriram Santhanagopalan

    2016-04-01

    Manufacturing capacity for lithium-ion batteries (LIBs) — which power many consumer electronics and are increasingly used to power electric vehicles — is heavily concentrated in East Asia. To illuminate the factors that drive regional competitiveness in automotive LIB cell production, this study models cell manufacturing cost and minimum sustainable price, and examines development of LIB supply chains and current LIB market conditions. The study shows that factors driving the cost competitiveness of LIB manufacturing locations are mostly built—supply chain developments and competition, access to materials, and production expertise. Some regional costs — including cost of capital, labor, and materials — are significant and should be considered.

  1. Estimating External Costs of Transportation in Regional Areas: Using Available Statistical Data the Case of the Region of Campania

    Directory of Open Access Journals (Sweden)

    Mariano Gallo

    2010-04-01

    Full Text Available In this paper simplified methods for estimating the external costs due to transportation in regional areas are proposed. The methods are based on data available by national and regional statistical sources and do not need specific surveys; they allow obtaining approximate estimates useful for a preliminary evaluation of transportation plans, policies and projects. In more detail, a negative externality is defined as a cost that is produced by subject A and is borne by subject B; moreover, subject A does not consider the effects of his/her behavior on subject B and does not compensate subject B for the costs that this last one is forced to bear. In this paper after a literature review on methodologies proposed for estimating external costs, in national and international ambits, the main external costs produced by transportation systems in the Region of Campania are estimated. The main external costs considered are: greenhouse gas emissions, air pollution, noise, accidents and congestion. In the paper the secondary external costs are neglected; the main ones are: water and soil pollution; landscape and nature damages; upstream and downstream effects; visual intrusion; separation effects; soil occupancy. In this paper the external costs estimated are the ones produced not only by road traffic, that anyway is the main “culprit”, but also by rail and air transportation systems. The evaluation of external costs has required the collection of several data on the regional mobility and the estimation of veh-kms per year produced in Campania by cars and freight vehicles. The estimation of veh-kms per year is based on circulating vehicles, subdivided by the COPERT classification, and on average yearly distances covered by each vehicle class. Other regional statistical data are collected about regional rail transport and air services at the main airports of the region. Moreover, since the evaluation of some external costs is based on damages on human

  2. The spread amongst ENSEMBLES regional scenarios: regional climate models, driving general circulation models and interannual variability

    Energy Technology Data Exchange (ETDEWEB)

    Deque, M.; Somot, S. [Meteo-France, Centre National de Recherches Meteorologiques, CNRS/GAME, Toulouse Cedex 01 (France); Sanchez-Gomez, E. [Cerfacs/CNRS, SUC URA1875, Toulouse Cedex 01 (France); Goodess, C.M. [University of East Anglia, Climatic Research Unit, Norwich (United Kingdom); Jacob, D. [Max Planck Institute for Meteorology, Hamburg (Germany); Lenderink, G. [KNMI, Postbus 201, De Bilt (Netherlands); Christensen, O.B. [Danish Meteorological Institute, Copenhagen Oe (Denmark)

    2012-03-15

    Various combinations of thirteen regional climate models (RCM) and six general circulation models (GCM) were used in FP6-ENSEMBLES. The response to the SRES-A1B greenhouse gas concentration scenario over Europe, calculated as the difference between the 2021-2050 and the 1961-1990 means can be viewed as an expected value about which various uncertainties exist. Uncertainties are measured here by variance explained for temperature and precipitation changes over eight European sub-areas. Three sources of uncertainty can be evaluated from the ENSEMBLES database. Sampling uncertainty is due to the fact that the model climate is estimated as an average over a finite number of years (30) despite a non-negligible interannual variability. Regional model uncertainty is due to the fact that the RCMs use different techniques to discretize the equations and to represent sub-grid effects. Global model uncertainty is due to the fact that the RCMs have been driven by different GCMs. Two methods are presented to fill the many empty cells of the ENSEMBLES RCM x GCM matrix. The first one is based on the same approach as in FP5-PRUDENCE. The second one uses the concept of weather regimes to attempt to separate the contribution of the GCM and the RCM. The variance of the climate response is analyzed with respect to the contribution of the GCM and the RCM. The two filling methods agree that the main contributor to the spread is the choice of the GCM, except for summer precipitation where the choice of the RCM dominates the uncertainty. Of course the implication of the GCM to the spread varies with the region, being maximum in the South-western part of Europe, whereas the continental parts are more sensitive to the choice of the RCM. The third cause of spread is systematically the interannual variability. The total uncertainty about temperature is not large enough to mask the 2021-2050 response which shows a similar pattern to the one obtained for 2071-2100 in PRUDENCE. The uncertainty

  3. Use of a Combination of Regional and General Anesthesia during Emergency Thoracic Surgery

    Directory of Open Access Journals (Sweden)

    V. Kh. Sharipova

    2015-01-01

    Full Text Available Objective: to elaborate multimodal anesthetic regimens and to evaluate their efficiency during emergency thoracic surgeries for varying injuries. Subjects and methods. A total of 116 patients emergently admitted to the Republican Research Center for Emergency Medical Care for chest traumatic injuries were examined and divided into 3 groups according to the mode of anesthesia. Results. Perioperative multimodal anesthetic regimens for emergency thoracic surgery, which involved all components of the pathogenesis of pain, were elaborated. Conclusion. The combination of regional and general anesthesia contributes to the smooth course of an intra operative period with minimal hemodynamic stress and it is cost effective in decreasing the use of narcotic anal gesics in the intraoperative period. 

  4. Construction of road network vulnerability evaluation index based on general travel cost

    Science.gov (United States)

    Leng, Jun-qiang; Zhai, Jing; Li, Qian-wen; Zhao, Lin

    2018-03-01

    With the development of China's economy and the continuous improvement of her urban road network, the vulnerability of the urban road network has attracted increasing attention. Based on general travel cost, this work constructs the vulnerability evaluation index for the urban road network, and evaluates the vulnerability of the urban road network from the perspective of user generalised travel cost. Firstly, the generalised travel cost model is constructed based on vehicle cost, travel time, and traveller comfort. Then, the network efficiency index is selected as an evaluation index of vulnerability: the network efficiency index is composed of the traffic volume and the generalised travel cost, which are obtained from the equilibrium state of the network. In addition, the research analyses the influence of traffic capacity decrease, road section attribute value, and location of road section, on vulnerability. Finally, the vulnerability index is used to analyse the local area network of Harbin and verify its applicability.

  5. Costs of delivering human papillomavirus vaccination to schoolgirls in Mwanza Region, Tanzania

    Science.gov (United States)

    2012-01-01

    Background Cervical cancer is the leading cause of female cancer-related deaths in Tanzania. Vaccination against human papillomavirus (HPV) offers a new opportunity to control this disease. This study aimed to estimate the costs of a school-based HPV vaccination project in three districts in Mwanza Region (NCT ID: NCT01173900), Tanzania and to model incremental scaled-up costs of a regional vaccination program. Methods We first conducted a top-down cost analysis of the vaccination project, comparing observed costs of age-based (girls born in 1998) and class-based (class 6) vaccine delivery in a total of 134 primary schools. Based on the observed project costs, we then modeled incremental costs of a scaled-up vaccination program for Mwanza Region from the perspective of the Tanzanian government, assuming that HPV vaccines would be delivered through the Expanded Programme on Immunization (EPI). Results Total economic project costs for delivering 3 doses of HPV vaccine to 4,211 girls were estimated at about US$349,400 (including a vaccine price of US$5 per dose). Costs per fully-immunized girl were lower for class-based delivery than for age-based delivery. Incremental economic scaled-up costs for class-based vaccination of 50,290 girls in Mwanza Region were estimated at US$1.3 million. Economic scaled-up costs per fully-immunized girl were US$26.41, including HPV vaccine at US$5 per dose. Excluding vaccine costs, vaccine could be delivered at an incremental economic cost of US$3.09 per dose and US$9.76 per fully-immunized girl. Financial scaled-up costs, excluding costs of the vaccine and salaries of existing staff were estimated at US$1.73 per dose. Conclusions Project costs of class-based vaccination were found to be below those of age-based vaccination because of more eligible girls being identified and higher vaccine uptake. We estimate that vaccine can be delivered at costs that would make HPV vaccination a very cost-effective intervention. Potentially

  6. Cost implication of irrational prescribing of chloroquine in Lagos State general hospitals.

    Science.gov (United States)

    Aina, Bolajoko A; Tayo, Fola; Taylor, Ogori

    2008-02-01

    A major share of the hospital budget is spent on drugs. Irrational use of these drugs is a waste of financial and human resources that could have been deployed for another use within the hospital setting especially in cases where such drugs are provided free to patients. Also there is increased morbidity and progression of severity with irrational use. The objective of this study was to determine the irrational use of chloroquine and the subsequent cost implications in Lagos State general hospitals. A retrospective study period of one year (January to December, 2000) was selected. A total of 18,781 prescription forms of "Free Eko Malaria" were sampled for children and adults from all the Lagos State general hospitals. Drug costs in each prescription form were identified. Cost effectiveness analysis of chloroquine tablet and intramuscular injection was undertaken. The average cost of medicine per prescription was 132.071 ($1.03) which should have been 94.22 ($0.73) if prescribed rationally. The total cost of prescriptions for malaria under study was 2,480,425.00 ($19,348.09). About 68% {(1,679,444.00) ($13,100.19)} of the total cost was lost to irrational prescribing. This is a waste of scarce resources. When the prescriptions were differentiated into the different dosage forms prescribed, the prescriptions containing intramuscular injections only had over 90% of the cost lost to irrational prescribing. Cost effectiveness analysis showed that chloroquine tablet was 17 times more cost effective than chloroquine injection (intramuscular) from a health care system perspective while it was 14 times more cost effective from a patient perspective. There is waste of scarce resources with irrational dispensing of drugs and these resources could have been deployed to other uses or areas within the hospitals. The tablet chloroquine was more cost effective than injection chloroquine (intramuscular). Increasing the cost of tablets, decreasing effectiveness of tablets

  7. Prevalence and cost of hospital medical errors in the general and elderly United States populations.

    Science.gov (United States)

    Mallow, Peter J; Pandya, Bhavik; Horblyuk, Ruslan; Kaplan, Harold S

    2013-12-01

    The primary objective of this study was to quantify the differences in the prevalence rate and costs of hospital medical errors between the general population and an elderly population aged ≥65 years. Methods from an actuarial study of medical errors were modified to identify medical errors in the Premier Hospital Database using data from 2009. Visits with more than four medical errors were removed from the population to avoid over-estimation of cost. Prevalence rates were calculated based on the total number of inpatient visits. There were 3,466,596 total inpatient visits in 2009. Of these, 1,230,836 (36%) occurred in people aged ≥ 65. The prevalence rate was 49 medical errors per 1000 inpatient visits in the general cohort and 79 medical errors per 1000 inpatient visits for the elderly cohort. The top 10 medical errors accounted for more than 80% of the total in the general cohort and the 65+ cohort. The most costly medical error for the general population was postoperative infection ($569,287,000). Pressure ulcers were most costly ($347,166,257) in the elderly population. This study was conducted with a hospital administrative database, and assumptions were necessary to identify medical errors in the database. Further, there was no method to identify errors of omission or misdiagnoses within the database. This study indicates that prevalence of hospital medical errors for the elderly is greater than the general population and the associated cost of medical errors in the elderly population is quite substantial. Hospitals which further focus their attention on medical errors in the elderly population may see a significant reduction in costs due to medical errors as a disproportionate percentage of medical errors occur in this age group.

  8. Do Cost Functions for Tracking Error Generalize across Tasks with Different Noise Levels?

    Directory of Open Access Journals (Sweden)

    Jonathon Sensinger

    Full Text Available Control of human-machine interfaces are well modeled by computational control models, which take into account the behavioral decisions people make in estimating task dynamics and state for a given control law. This control law is optimized according to a cost function, which for the sake of mathematical tractability is typically represented as a series of quadratic terms. Recent studies have found that people actually use cost functions for reaching tasks that are slightly different than a quadratic function, but it is unclear which of several cost functions best explain human behavior and if these cost functions generalize across tasks of similar nature but different scale. In this study, we used an inverse-decision-theory technique to reconstruct the cost function from empirical data collected on 24 able-bodied subjects controlling a myoelectric interface. Compared with previous studies, this experimental paradigm involved a different control source (myoelectric control, which has inherently large multiplicative noise, a different control interface (control signal was mapped to cursor velocity, and a different task (the tracking position dynamically moved on the screen throughout each trial. Several cost functions, including a linear-quadratic; an inverted Gaussian, and a power function, accurately described the behavior of subjects throughout this experiment better than a quadratic cost function or other explored candidate cost functions (p<0.05. Importantly, despite the differences in the experimental paradigm and a substantially larger scale of error, we found only one candidate cost function whose parameter was consistent with the previous studies: a power function (cost ∝ errorα with a parameter value of α = 1.69 (1.53-1.78 interquartile range. This result suggests that a power-function is a representative function of user's error cost over a range of noise amplitudes for pointing and tracking tasks.

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

    Science.gov (United States)

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

    2015-03-01

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

  10. A general theory to explain the relatively high cost of environmental restoration at DOE facilities

    International Nuclear Information System (INIS)

    Sullivan, W.H.

    1995-01-01

    Environmental Restoration costs for Department of Energy (DOE) facilities have been the subject of much scrutiny and concern for several years. General opinion is that DOE clean-up costs are as much as three times higher than costs for similar clean-up projects in the private sector. Consequently, DOE Environmental Restoration professionals are continually under pressure to do more with less, which, ironically, can lead to additional inefficiencies in the system. This paper proposes a general theory as to why DOE costs are higher, explains the reasons why current conditions will make it difficult to realize any pervasive or significant decreases in clean-up costs, and presents some general changes that need to take place in the DOE system in order to bring about conditions that will allow more efficient clean-up to occur. The theory is based on a simple economic model that describes the balance between the resources spent for risk avoidance and the corresponding changes in overall productivity as a function of risk. The elementary concepts illustrated with the economic model, when refined and specifically applied, have the potential to become the catalyst for significant change-change that is absolutely necessary if we truly intend to conduct environmental clean-up with the same efficiencies as private industry

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

    Science.gov (United States)

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

    2017-06-01

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

  12. Prevalence and Cost Analysis of Complex Regional Pain Syndrome (CRPS): A Role for Neuromodulation.

    Science.gov (United States)

    Elsamadicy, Aladine A; Yang, Siyun; Sergesketter, Amanda R; Ashraf, Bilal; Charalambous, Lefko; Kemeny, Hanna; Ejikeme, Tiffany; Ren, Xinru; Pagadala, Promila; Parente, Beth; Xie, Jichun; Lad, Shivanand P

    2017-09-29

    The diagnosis and treatment of complex regional pain syndrome (CRPS) is challenging and there is a paucity of data describing its overall cost burden and quantifying its impact on the US healthcare system. The aim of this study was to assess the prevalence and healthcare utilization costs associated with CRPS. A retrospective longitudinal study was performed using the Truven MarketScan® database to identify patients with a new indexed diagnosis of CRPS (Type I, II, or both) from 2001 to 2012. We collected total, outpatient, and pain prescription costs three years prior to CRPS diagnosis (baseline), at year of CRPS diagnosis, and eight-year post-CRPS diagnosis. A longitudinal multivariate analysis was used to model the estimated total and pain prescription cost ratios comparing patients diagnosed before and after CRPS. We included 35,316 patients with a newly indexed diagnosis of CRPS (Type I: n = 18,703, Type II: n = 14,599, Unspecified: n = 2014). Baseline characteristics were similar between the CRPS cohorts. Compared to two- and three-year baseline costs, one-year prior to diagnosis for all CRPS patients yielded the highest interquartile median [IQR] costs: total costs $7904[$3469, $16,084]; outpatient costs $6706[$3119, $12,715]; and pain prescription costs $1862[$147, $7649]. At the year of CRPS diagnosis, the median [IQR] costs were significantly higher than baseline costs: total costs $8508[$3943, $16,666]; outpatient costs $7251[$3527, $13,568]; and pain prescription costs $2077[$140, $8856]. Over the eight-year period after CRPS diagnosis, costs between all the years were similar, ranging from the highest (one-year) to lowest (seven-years), $4845 to $3888. The median total cumulative cost 8-years after CRPS diagnosis was $43,026 and $12,037 for pain prescription costs. [Correction added on 06 November 2017 after first online publication: the preceding sentence has been updated to demonstrate the median cumulative cost in replacement of the

  13. 2 CFR Appendix A to Part 225 - General Principles for Determining Allowable Costs

    Science.gov (United States)

    2010-01-01

    ... based on the fundamental premises that: (1) Governmental units are responsible for the efficient and... reduce the burden associated with maintaining systems for charging administrative costs to Federal... reasonable and necessary for operating these programs, and funds are not used for general expenses required...

  14. 26 CFR 1.468A-1T - Nuclear decommissioning costs; general rules (temporary).

    Science.gov (United States)

    2010-04-01

    ... accrual method of accounting that do not elect the application of section 468A are not allowed a deduction... (temporary). 1.468A-1T Section 1.468A-1T Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE...-1T Nuclear decommissioning costs; general rules (temporary). (a) Introduction. Section 468A provides...

  15. Comparison of seating, powered characteristics and functions and costs of electrically powered wheelchairs in a general population of users.

    Science.gov (United States)

    Dolan, Michael John; Bolton, Megan Jennifer; Henderson, Graham Iain

    2017-10-26

    To profile and compare the seating and powered characteristics and functions of electrically powered wheelchairs (EPWs) in a general user population including equipment costs. Case notes of adult EPW users of a regional NHS service were reviewed retrospectively. Seating equipment complexity and type were categorized using the Edinburgh classification. Powered characteristics and functions, including control device type, were recorded. 482 cases were included; 53.9% female; mean duration EPW use 8.1 years (SD 7.4); rear wheel drive 88.0%; hand joystick 94.8%. Seating complexity: low 73.2%, medium 18.0%, high 8.7%. Most prevalent diagnoses: multiple sclerosis (MS) 25.3%, cerebral palsy (CP) 18.7%, muscular dystrophy (8.5%). Compared to CP users, MS users were significantly older at first use, less experienced, more likely to have mid-wheel drive and less complex seating. Additional costs for muscular dystrophy and spinal cord injury users were 3-4 times stroke users. This is the first large study of a general EPW user population using a seating classification. Significant differences were found between diagnostic groups; nevertheless, there was also high diversity within each group. The differences in provision and the equipment costs across diagnostic groups can be used to improve service planning. Implications for Rehabilitation At a service planning level, knowledge of a population's diagnostic group and age distribution can be used to inform decisions about the number of required EPWs and equipment costs. At a user level, purchasing decisions about powered characteristics and functions of EPWs and specialised seating equipment need to be taken on a case by case basis because of the diversity of users' needs within diagnostic groups. The additional equipment costs for SCI and MD users are several times those of stroke users and add between 60 and 70% of the cost of basic provision.

  16. Use, cost, complications, and mortality of robotic versus nonrobotic general surgery procedures based on a nationwide database.

    Science.gov (United States)

    Salman, Muhammad; Bell, Theodore; Martin, Jennifer; Bhuva, Kalpesh; Grim, Rod; Ahuja, Vanita

    2013-06-01

    Since its introduction in 1997, robotic surgery has overcome many limitations, including setup costs and surgeon training. The use of robotics in general surgery remains unknown. This study evaluates robotic-assisted procedures in general surgery by comparing characteristics with its nonrobotic (laparoscopic and open) counterparts. Weighted Healthcare Cost and Utilization Project Nationwide Inpatient Sample data (2008, 2009) were used to identify the top 12 procedures for robotic general surgery. Robotic cases were identified by Current Procedural Terminology codes 17.41 and 17.42. Procedures were grouped: esophagogastric, colorectal, adrenalectomy, lysis of adhesion, and cholecystectomy. Analyses were descriptive, t tests, χ(2)s, and logistic regression. Charges and length of stay were adjusted for gender, age, race, payer, hospital bed size, hospital location, hospital region, median household income, Charlson score, and procedure type. There were 1,389,235 (97.4%) nonrobotic and 37,270 (2.6%) robotic cases. Robotic cases increased from 0.8 per cent (2008) to 4.3 per cent (2009, P robotic surgery had significantly shorter lengths of stay (4.9 days) than open surgery (6.1 days) and lower charges (median $30,540) than laparoscopic ($34,537) and open ($46,704) surgery. Fewer complications were seen in robotic-assisted colorectal, adrenalectomy and lysis of adhesion; however, robotic cholecystectomy and esophagogastric procedures had higher complications than nonrobotic surgery (P robotic surgery had a lower mortality rate (0.097%) than nonrobotic surgeries per 10,000 procedures (laparoscopic 0.48%, open 0.92%; P robotic surgery is generally considered a prohibitive factor. In the present study, when overall cost was considered, including length of stay, robotic surgery appeared to be cost-effective and as safe as nonrobotic surgery except in cholecystectomy and esophagogastric procedures. Further study is needed to fully understand the long-term implications of

  17. 48 CFR 9904.410 - Allocation of business unit general and administrative expenses to final cost objectives.

    Science.gov (United States)

    2010-10-01

    ... unit general and administrative expenses to final cost objectives. 9904.410 Section 9904.410 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING...

  18. Allocation of Home Office Expenses to Segments and Business Unit General and Administrative Expenses to Final Cost Objectives

    Science.gov (United States)

    1992-02-16

    3 0 B. Cost Accounting Standard 418 ..................................................... 3 1 1. D efinitio n s ...objective" as an activity for which a separate measurement of cost is desired. C. Horngren , Cost Accounting . A Managerial Emphasis 21 (5th ed. 1982...Segments and Business Unit General and Administrative Expenses to Final Cost Objectives 6. AUTHOR( S ) Stephen Thomas Lynch, Major 7. PERFORMING

  19. Cost-benefit analysis of multi-regional nuclear energy systems deployment

    International Nuclear Information System (INIS)

    Van Den Durpel, L.G.G.; Wade, D.C.; Yacout, A.M.

    2007-01-01

    The paper describes the preliminary results of a cost/benefit-analysis of multi-regional nuclear energy system approaches with a focus on how multi-regional approaches may benefit a growing nuclear energy system in various world regions also being able to limit, or even reduce, the costs associated with the nuclear fuel cycle and facilitating the introduction of nuclear energy in various regions in the world. The paper highlights the trade-off one might envisage in deploying such multi-regional approaches but also the pay backs possible and concludes on the economical benefits one may associate to regional fuel cycle centres serving a world-fleet of STAR (small fast reactors of long refueling interval) where these STARs may be competitive compared to the LWRs (Light Water Reactors) as a base-case nuclear reactor option. (authors)

  20. The Costs of Producing Biodiesel from Microalgae in the Asia-Pacific Region

    Directory of Open Access Journals (Sweden)

    G.J. Griffin

    2013-10-01

    Full Text Available Capital and operating cost estimates for converting microalgae to oil or biodiesel are compared. These cost comparisons are based on Australian locations, which are expected to fall at the lower end of the cost spectrum in the Asia-Pacific Region and other parts of the world.  It is assumed that microalgae are grown in a concentrated saltwater medium in raceway ponds, then are harvested, dewatered and the oil is extracted and converted to biodiesel by transesterification. The size of the desired pond system affects the number of potential locations due to constraints in resource availability. Cost estimates vary significantly due to differences in the assumed oil productivity, the harvesting equipment and the method of converting residual biomass to electric power. A comparison is made with recent cost estimates from other parts of the world, in which the expected costs of microalgae oil production from a number of publicly available sources lay between 0.34–31.0 USD/L.  The resulting cost estimates of between 1.37—2.66 USD/L are at the lower end of this scale, thereby confirming that Australia has the potential to be a low-cost producer of algal oil and biodiesel in the Asia-Pacific Region.  It was significant that, despite similar assumptions for the microalgae-to-oil process, cost estimates for the final biodiesel or oil price differed by a factor of 2.  This highlights the high degree of uncertainty in such economic predictions. Keywords: Asia-Pacific region; biodiesel; economics; microalgaeThis article is cited as :Griffin, G., Batten, D., Beer, T., & Campbell, P. (2013. The Costs of Producing Biodiesel from Microalgae in the Asia-Pacific Region. International Journal Of Renewable Energy Development (IJRED, 2(3, 105-113. doi:10.14710/ijred.2.3.105-113Permalinkhttp://dx.doi.org/10.14710/ijred.2.3.105-113

  1. A theoretical cost optimization model of reused flowback distribution network of regional shale gas development

    International Nuclear Information System (INIS)

    Li, Huajiao; An, Haizhong; Fang, Wei; Jiang, Meng

    2017-01-01

    The logistical issues surrounding the timing and transport of flowback generated by each shale gas well to the next is a big challenge. Due to more and more flowback being stored temporarily near the shale gas well and reused in the shale gas development, both transportation cost and storage cost are the heavy burden for the developers. This research proposed a theoretical cost optimization model to get the optimal flowback distribution solution for regional multi shale gas wells in a holistic perspective. Then, we used some empirical data of Marcellus Shale to do the empirical study. In addition, we compared the optimal flowback distribution solution by considering both the transportation cost and storage cost with the flowback distribution solution which only minimized the transportation cost or only minimized the storage cost. - Highlights: • A theoretical cost optimization model to get optimal flowback distribution solution. • An empirical study using the shale gas data in Bradford County of Marcellus Shale. • Visualization of optimal flowback distribution solutions under different scenarios. • Transportation cost is a more important factor for reducing the cost. • Help the developers to cut the storage and transportation cost of reusing flowback.

  2. The health regionalization process from the perspective of the transation cost theory.

    Science.gov (United States)

    Sancho, Leyla Gomes; Geremia, Daniela Savi; Dain, Sulamis; Geremia, Fabiano; Leão, Cláudio José Silva

    2017-04-01

    This study analyzes the incidence of transaction costs in the regionalization process of health policies in the Brazilian federal system. In this work, regionalized health actions contracted and agreed between federal agencies have assumed a transactional nature. A conceptual theoretical essay of reflective nature was prepared with the purpose of questioning and proposing new approaches to improve the health regionalization process. The main considerations suggest that institutional management tools proposed by the standards and regulations of the Unified Health System have a low potential to reduce transaction costs, especially due to hardships in reconciling common goals among the entities, environment surrounded by uncertainty, asymmetries and incomplete information, bounded rationality and conflict of interest. However, regionalization can reduce the incidence of social and/or operational costs, through improved access to health and the construction of more efficient governance models.

  3. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

    Science.gov (United States)

    Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang

    2013-01-01

    With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (Phospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.

  4. Total costs and benefits of biomass in selected regions of the European Union - BioCosts

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, A de; Costa, F B [Coimbra Univ. (Portugal). Inst. de Sistemas e Robotica; Bauen, A [London Univ. (United Kingdom). Div. of Life Sciences; and others

    1998-11-01

    In the BioCosts project, representative biomass-to-electricity and biomass-to-transport-service fuel cycles located at different sites within the European Union have been evaluated concerning their environmental and economic performance. Each case study was compared to a fossil-fuel fired reference case. The case studies examined comprise: utilisation of forestry residues in the Naessjoe circulating fluidized bed combustion plant, Sweden, versus the use of Polish coal in the same plant; utilisation of forestry residues and short-rotation coppice for industrial combined heat and power production in Mangualde, Portugal, versus the use of fuel oil in an engine generating heat and power; production of biogas from manure slurry for municipal combined heat and power generation at Hashoej, Denmark, versus the use of Danish natural gas in the same engine; gasification of woody biomass for combined heat and power generation in Vaernamo, Sweden, and Eggborough, UK, versus the use of coal in the Naessjoe plant mentioned above and a UK power plant; production of cold-pressed rape-seed oil and its use in a cogeneration plant at Weissenburg, Germany, versus the use of diesel fuel in a similar engine; production of rape-seed oil methyl ester and its use for goods transport in Germany, versus the use of diesel fuel in the same fleet of trucks; production of ethyl tertiary butyl ether from sugar beets and sweet sorghum for transport applications in France, versus the use of methyl tertiary butyl ether from fossil sources for the same purpose 130 refs, 25 figs, 42 tabs. Research funded in part by the European Commission in the JOULE III programme

  5. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

    Directory of Open Access Journals (Sweden)

    Lue-Ping Zhao

    Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role

  6. Low-Cost Quality Control and Nondestructive Evaluation Technologies for General Aviation Structures

    Science.gov (United States)

    Cramer, K. Elliott; Gavinsky, Bob; Semanskee, Grant

    1998-01-01

    NASA's Advanced General Aviation Transport Experiments (AGATE) Program has as a goal to reduce the overall cost of producing private aviation aircraft while maintaining the safety of these aircraft. In order to successfully meet this goal, it is necessary to develop nondestructive inspection techniques which will facilitate the production of the materials used in these aircraft and assure the quality necessary to maintain airworthiness. This paper will discuss a particular class of general aviation materials and several nondestructive inspection techniques that have proven effective for making these inspections. Additionally, this paper will discuss the investigation and application of other commercially available quality control techniques applicable to these structures.

  7. Historical Cost Dan General Price Level Accounting: Analisis Relevansi Indikator Keuangan

    OpenAIRE

    -, Meythi; Teresa, Sheffie

    2012-01-01

    In conventional accounting, financial statements are based on the historical cost principle that assumes that prices (monetary unit) are stable. Conventional accounting recognizes neither changes in the general price level nor changes in the specific price level. Consequently, if there are any changes in purchasing power such as in inflation period, the historical financial statement are not economically relevant and also income is usually overstated, and the fixed assets are usually understa...

  8. [A totally implantable venous access device. Implantation in general or local anaesthesia? A retrospective cost analysis].

    Science.gov (United States)

    Schuld, J; Richter, S; Moussavian, M R; Kollmar, O; Schilling, M K

    2009-08-01

    Implantation of venous access port systems can be performed in local or general anesthesia. In spite of the increasing rate of interventionally implanted systems, the surgical cut-down represents a safe alternative. Thus, the question arises whether--in context to the increasing health-economic pressure--open implantation in general anesthesia is still a feasible alternative to implantation in local anesthesia regarding OR efficiency and costs. In a retrospective analysis, 993 patients receiving a totally implantable venous access device between 2001 and 2007 were evaluated regarding OR utilization, turnover times, intraoperative data and costs. Implantations in local (LA) and general anesthesia (GA) were compared. GA was performed in 762 cases (76.6 %), LA was performed in 231 patients (23.3 %). Mean operation time was similar in both groups (LA 47.27 +/- 1.40 min vs. GA 45.41 +/- 0.75 min, p = 0.244). Patients receiving local anesthesia had a significantly shorter stay in the OR unit (LA 95.9 +/- 1.78 min vs. GA 105.92 +/- 0.92 min; p cut (LA 39.57 +/- 0.69 min vs. GA 50.46 +/- 0.52 min; p material costs were significantly lower in the LA group compared with the GA group (LA: 400.72 +/- 8.25 euro vs. GA: 482.86 +/- 6.23 euro; p systems in local anesthesia is superior in comparison to the implantation under general anesthesia regarding procedural times in the OR unit and costs. With the same operation duration, but less personnel and material expenditure, implantation in local anesthesia offers a potential economic advantage by permitting faster changing times. Implantation in GA only should be performed at a special request by the patient or in difficult venous conditions. Georg Thieme Verlag Stuttgart.New York.

  9. Design of low-cost general purpose microcontroller based neuromuscular stimulator.

    Science.gov (United States)

    Koçer, S; Rahmi Canal, M; Güler, I

    2000-04-01

    In this study, a general purpose, low-cost, programmable, portable and high performance stimulator is designed and implemented. For this purpose, a microcontroller is used in the design of the stimulator. The duty cycle and amplitude of the designed system can be controlled using a keyboard. The performance test of the system has shown that the results are reliable. The overall system can be used as the neuromuscular stimulator under safe conditions.

  10. Physical activity coaching by Australian Exercise Physiologists is cost effective for patients referred from general practice.

    Science.gov (United States)

    Ewald, Ben; Stacey, Fiona; Johnson, Natalie; Plotnikoff, Ronald C; Holliday, Elizabeth; Brown, Wendy; James, Erica L

    2018-02-01

    Interventions to promote physical activity for sedentary patients seen in general practice may be a way to reduce the burden of chronic disease. Coaching by an exercise physiologist is publicly funded in Australia, but cost effectiveness has not been documented. In a three-arm randomised controlled trial, face-to-face coaching and telephone coaching over 12 weeks were compared with a control group using the outcome of step count for one week at baseline, three months and twelve months. Program costs and time-based costs were considered. Quality of life was measured as a secondary outcome. At 12 months, the intervention groups were more active than controls by 1,002 steps per day (95%CI 244, 1,759). This was achieved at a cost of AUD$245 per person. There was no change in reported quality of life or utility values. Coaching achieved a modest increase in activity equivalent to 10 minutes walking per day, at a cost of AUD$245 per person. Face-to-face and telephone counselling were both effective. Implication for public health: Persistence of increases nine months after the end of coaching suggests it creates long-term change and is a good value health intervention. © 2017 The Authors.

  11. Cost-effectiveness of USAID's regional program for family planning in West Africa.

    Science.gov (United States)

    Shepard, Donald S; Bail, Richard N; Merritt, C Gary

    2003-06-01

    Between 1994 and 1996, the United States Agency for International Development (USAID) closed 23 country missions worldwide, of which eight were in West and Central Africa. To preserve United States support for family planning and reproductive health in four countries in that region, USAID created a subregional program through a consortium of US-based groups that hired mainly African managers and African organizations. This study assesses cost-effectiveness of the program through an interrupted time-series design spanning the 1990s and compares cost-effectiveness in four similar countries in which mission-based programs continued. Key indicators include costs, contraceptive prevalence rates, and imputed "women-years of protection." The study found that, taking into account all external financing for population and family planning, the USAID West Africa regional approach generated women-years of protection at one-third the cost of the mission-based programs. This regional approach delivered family planning assistance in West Africa cost-effectively, and the findings suggest that regional models may work well for many health and population services in small countries.

  12. Cost of paricá wood production in Paragominas region, Para State, Brazil

    Directory of Open Access Journals (Sweden)

    Rafaela da Silveira

    2017-12-01

    Full Text Available The silvicultural and economic potential of paricá (Schizolobium amazonicum has encouraged the expansion of this crop, mainly in the northern region of the country, provoking the need for studies on the species. The objective of this study was to estimate paricá production in Paragominas region, Para State, Brazil, at 5, 6 and 7 years, in three classes of productivity considering five plant arrangements, being identified the main costs of production, in addition to those most affected by plant arrangements. The volumetric estimation was obtained by modeling in population level and the analysis of the costs, through the methodology of the operational cost. It was possible to infer that the arrangement of plants 3 m x 2 m was superior in volume, compared to the other analyzed plant arrangements. The effective operating cost represented on average 65% of the total production costs. Transport was the most significant individual cost, in all analyzed plant arrangements. The maintenance, among the set of activities, was the most significant in planting, fact that may be related to the number and the long period for the activities execution. Smaller plant arrangements presented the higher total costs of production, depending or not on the remuneration for the use of the permanent and current capital.

  13. Controlled trial of pharmacist intervention in general practice: the effect on prescribing costs.

    Science.gov (United States)

    Rodgers, S; Avery, A J; Meechan, D; Briant, S; Geraghty, M; Doran, K; Whynes, D K

    1999-09-01

    It has been suggested that the employment of pharmacists in general practice might moderate the growth in prescribing costs. However, empirical evidence for this proposition has been lacking. We report the results of a controlled trial of pharmacist intervention in United Kingdom general practice. To determine whether intervention practices made savings relative to controls. An evaluation of an initiative set up by Doncaster Health Authority. Eight practices agreed to take part and received intensive input from five pharmacists for one year (September 1996 to August 1997) at a cost of 163,000 Pounds. Changes in prescribing patterns were investigated by comparing these practices with eight individually matched controls for both the year of the intervention and the previous year. Prescribing data (PACTLINE) were used to assess these changes. The measures used to take account of differences in the populations of the practices included the ASTRO-PU for overall prescribing and the STAR-PU for prescribing in specific therapeutic areas. Differences between intervention and control practices were subjected to Wilcoxon matched-pairs, signed-ranks tests. The median (minimum to maximum) rise in prescribing costs per ASTRO-PU was 0.85 Pound (-1.95 Pounds to 2.05 Pounds) in the intervention practices compared with 2.55 Pounds (1.74 Pounds to 4.65 Pounds) in controls (P = 0.025). Had the cost growth of the intervention group been as high as that of the controls, their total prescribing expenditure would have been around 347,000 Pounds higher. This study suggests that the use of pharmacists did control prescribing expenditure sufficiently to offset their employment costs.

  14. Actuarial modeling of cost of voluntary pension insurance of the population of the region

    Directory of Open Access Journals (Sweden)

    Mikhailova Svetlana Sergeevna

    2013-06-01

    Full Text Available In article approach to determination of net value of the contract of pension insurance for the man's and female population, considering regional demographic features is offered. Results of actuarial calculation of the size pure net - rates of individual pension insurance are presented, "sensitivity" of cost of insurance is defined by methods of statistical modeling to key parameters of a pension product for the region population.

  15. The effects of regional insolation differences upon advanced solar thermal electric power plant performance and energy costs

    Science.gov (United States)

    Latta, A. F.; Bowyer, J. M.; Fujita, T.

    1979-01-01

    This paper presents the performance and cost of four 10-MWe advanced solar thermal electric power plants sited in various regions of the continental United States. Each region has different insolation characteristics which result in varying collector field areas, plant performance, capital costs, and energy costs. The paraboloidal dish, central receiver, cylindrical parabolic trough, and compound parabolic concentrator (CPC) comprise the advanced concepts studied. This paper contains a discussion of the regional insolation data base, a description of the solar systems' performances and costs, and a presentation of a range for the forecast cost of conventional electricity by region and nationally over the next several decades.

  16. Inventory of past DOE land disturbance, Yucca Mountain, Nevada, and estimated general reclamation costs

    International Nuclear Information System (INIS)

    1989-04-01

    Since 1976, DOE preliminary investigations for a high level nuclear waste repository at Yucca Mountain, Nevada, have caused widespread disturbances of the landscape. This report addresses the areal extent of those disturbances that have accrued up to June 1988, and identifies expected associated reclamation costs. It was first necessary to identify disturbances, next to classify them for reclamation purposes, and, then, to assign general reclamation costs. The purposes of the analysis were: (1) to establish the amount of disturbance that already exists in the area of Yucca Mountain in order to identify alterations of the landscape that comprise the existing baseline conditions; (2) to identify estimated general reclamation costs for repair of the disturbances; (3) to provide information needed to establish disturbance models, and eventually environmental impact models, that can be applied to future DOE activities during Site Characterization and later phases of repository development, if they occur, and (4) to provide indicators of the needs for reclamation of future disturbances created by DOE's Site Characterization program. Disturbances were estimated using measurements from June 1988, large scale color aerial photography. Two reconnaissance site visits were also conducted. The identified disturbance totals by type are displayed in tabular form in the appendices. 84 refs., 2 figs., 9 tabs

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

    Science.gov (United States)

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

    1981-01-01

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

  18. Studi Banding Penyusunan Laporan Keuangan Dengan Metode Historical Cost Accounting Dan General Price Level Accounting Pada Masa Inflasi

    OpenAIRE

    Kodrat, David Sukardi

    2006-01-01

    Generally, Financial Statements are based on Historical Cost Accounting (HCA) that assumes that prices are stable. Actually, there are several methods on accounting for the effect of changing prices, such as Current Cost Accounting (Replacement Cost Accounting) and Constant Dollar Accounting or General Price Level Accounting (GPLA)). GPLA will do restatement the components of financial statement to be a rupiah on a similar level of purchasing power, but without changes in accounting principle...

  19. STUDI BANDING PENYUSUNAN LAPORAN KEUANGAN DENGAN METODE HISTORICAL COST ACCOUNTING DAN GENERAL PRICE LEVEL ACCOUNTING PADA MASA INFLASI

    OpenAIRE

    David Sukardi Kodrat

    2006-01-01

    Generally, Financial Statements are based on Historical Cost Accounting (HCA) that assumes that prices are stable. Actually, there are several methods on accounting for the effect of changing prices, such as Current Cost Accounting (Replacement Cost Accounting) and Constant Dollar Accounting or General Price Level Accounting (GPLA)). GPLA will do restatement the components of financial statement to be a rupiah on a similar level of purchasing power, but without changes in accounting principle...

  20. Regional differences in electricity distribution costs and their consequences for yardstick regulation of access prices

    International Nuclear Information System (INIS)

    Filippini, M.; Wild, J.

    2001-01-01

    In this paper we estimate an average-cost function for a panel of 59 Swiss local and regional electricity distribution utilities as a basis for yardstick regulation of the distribution-network access prices. Shleifer (1985) proposed yardstick competition in terms of price to regulate local monopolies producing a homogeneous good. The regulated price for the individual firms depends on the average costs of identical firms. The yardstick competition concept can also be applied to firms that produce heterogeneous goods if these goods differ only in observable characteristics. To correct the yardstick for heterogeneity the regulator can use a multivariate estimation of an average-cost function. In the case of electricity distribution, the heterogeneity of output consists mainly of different characteristics of the distribution service areas. In this paper we follow Shleifer's suggestion to estimate a multivariate average-cost function that can be employed by the regulatory commission to benchmark network access prices at the distribution level. Several exogenous variables measuring the heterogeneity of the service areas were included in the cost model specification. We find that the regional differences of the service areas - e.g. area shares of forests, agricultural areas or unproductive land and population density - significantly influence electricity distribution costs

  1. Social incidence and economic costs of carbon limits; A computable general equilibrium analysis for Switzerland

    Energy Technology Data Exchange (ETDEWEB)

    Stephan, G.; Van Nieuwkoop, R.; Wiedmer, T. (Institute for Applied Microeconomics, Univ. of Bern (Switzerland))

    1992-01-01

    Both distributional and allocational effects of limiting carbon dioxide emissions in a small and open economy are discussed. It starts from the assumption that Switzerland attempts to stabilize its greenhouse gas emissions over the next 25 years, and evaluates costs and benefits of the respective reduction programme. From a methodological viewpoint, it is illustrated how a computable general equilibrium approach can be adopted for identifying economic effects of cutting greenhouse gas emissions on the national level. From a political economy point of view it considers the social incidence of a greenhouse policy. It shows in particular that public acceptance can be increased and economic costs of greenhouse policies can be reduced, if carbon taxes are accompanied by revenue redistribution. 8 tabs., 1 app., 17 refs.

  2. A low cost general purpose portable programmable master/slave manipulative appliance

    International Nuclear Information System (INIS)

    Cameron, W.

    1984-01-01

    The TRIUMF 100 μA 500 MeV cyclotron, located at the University of British Columbia, required a low cost, portable master/slave manipulative capability for experimental beam line servicing. A programmable capability was also required for the hot cell manipulators. A general purpose unit was developed that might also have applications in light manufacturing and medical rehabilitation. The project now in prototype testing represents a modular portable robot costing less than $5000 that is lead-through-teach programmable by either a master controller or hands-on lead-through. Task programs are stored and retrieved on any 32 k personal computer. An on-board proportional integral derivative controller (Motorola 6809 based) gives discrete positioning of the six degrees of freedom 2 kg capacity end effector

  3. A comparison of antibiotic point prevalence survey data from four Irish regional/general hospitals.

    LENUS (Irish Health Repository)

    Naughton, C

    2011-06-01

    Point prevalence surveys (PPS) are increasingly used to examining and compare hospital antibiotic consumption. The aim of this study was to identify the (1) point prevalence of antibiotic use in one regional hospital and (2) compare PPS data from similar regional\\/general hospitals.

  4. Impact of connection density on regional cost differences for network operators in the Netherlands

    International Nuclear Information System (INIS)

    2009-04-01

    The Dutch Office of Energy Regulation ('Energiekamer') has an obligation to investigate the extent to which the electricity and gas distribution businesses (DNOs) in the Netherlands face different structural environments that result in regional cost differences which, in turn, could justify tariff differences. On the basis of previous studies, Energiekamer has identified 'water crossings' and 'local taxes' as allowable regional differences. To account for them, Energiekamer has introduced an adjustment to the regulated revenues formula in order to guarantee a level-playing field to the Dutch DNOs. In addition to these factors, it has been claimed that connection density may have an impact on distribution costs and that, therefore, regulated revenues should be adjusted to compensate for regional differences in connection density between DNOs. However, so far, the research in this field has been unable to identify a sufficiently robust relationship between cost and connection density to support this claim. In order to address this issue, Energiekamer has asked Frontier Economics and Consentec to further investigate the relationship between connection density and distribution costs in the Netherlands. Therefore, our analysis has aimed at determining whether, and to what extent, connection density in the Netherlands is a significant driver of the costs of electricity and gas distribution networks. The following three questions are answered: (1) Is connection density a significant cost driver in electricity and gas networks in the Netherlands?; (2) If so, which functional form (e.g. U-shaped) does this relationship have in the Netherlands?; (3) Finally, based on the evidence collected, is the influence of connection density sufficiently well-determined to be considered a regional difference in the Dutch regulatory framework?

  5. The first nationwide evaluation of robotic general surgery: a regionalized, small but safe start.

    Science.gov (United States)

    Wormer, Blair A; Dacey, Kristian T; Williams, Kristopher B; Bradley, Joel F; Walters, Amanda L; Augenstein, Vedra A; Stefanidis, Dimitrios; Heniford, B Todd

    2014-03-01

    The purpose of this study was to evaluate the outcomes of the most commonly performed robotic-assisted general surgery (RAGS) procedures in a nationwide database and compare them with their laparoscopic counterparts. The Nationwide Inpatient Sample was queried from October 2008 to December 2010 for patients undergoing elective, abdominal RAGS procedures. The two most common, robotic-assisted fundoplication (RF) and gastroenterostomy without gastrectomy (RG), were individually compared with the laparoscopic counterparts (LF and LG, respectively). During the study, 297,335 patients underwent abdominal general surgery procedures, in which 1,809 (0.6 %) utilized robotic-assistance. From 2009 to 2010, the incidence of RAGS nearly doubled from 573 to 1128 cases. The top five RAGS procedures by frequency were LG, LF, laparoscopic lysis of adhesions, other anterior resection of rectum, and laparoscopic sigmoidectomy. Eight of the top ten RAGS were colorectal or foregut operations. RG was performed in 282 patients (0.9 %) and LG in 29,677 patients (99.1 %). When comparing RG with LG there was no difference in age, gender, race, Charlson comorbidity index (CCI), postoperative complications, or mortality; however, length of stay (LOS) was longer in RG (2.5 ± 2.4 vs. 2.2 ± 1.5 days; p < 0.0001). Total cost for RG was substantially higher ($60,837 ± 28,887 vs. $42,743 ± 23,366; p < 0.0001), and more often performed at teaching hospitals (87.2 vs. 50.9 %; p < 0.0001) in urban areas (100 vs. 93.0 %; p < 0.0001). RF was performed in 272 patients (3.5 %) and LF in 7,484 patients (96.5 %). RF patients were more often male compared with LF (38.2 vs. 32.3 %; p < 0.05); however, there was no difference in age, race, CCI, LOS, or postoperative complications. RF was more expensive than LF ($37,638 ± 21,134 vs. $32,947 ± 24,052; p < 0.0001), and more often performed at teaching hospitals (72.4 vs. 54.9 %; p < 0.0001) in urban areas (98.5 vs. 88.7 %; p < 0.0001). This nationwide

  6. Shipping emission forecasts and cost-benefit analysis of China ports and key regions' control.

    Science.gov (United States)

    Liu, Huan; Meng, Zhi-Hang; Shang, Yi; Lv, Zhao-Feng; Jin, Xin-Xin; Fu, Ming-Liang; He, Ke-Bin

    2018-05-01

    China established Domestic Emission Control Area (DECA) for sulphur since 2015 to constrain the increasing shipping emissions. However, future DECA policy-makings are not supported due to a lack of quantitive evaluations. To investigate the effects of current and possible Chinese DECAs policies, a model is presented for the forecast of shipping emissions and evaluation of potential costs and benefits of an DECA policy package set in 2020. It includes a port-level and regional-level projection accounting for shipping trade volume growth, share of ship types, and fuel consumption. The results show that without control measures, both SO 2 and particulate matter (PM) emissions are expected to increase by 15.3-61.2% in Jing-Jin-Ji, the Yangtze River Delta, and the Pearl River Delta from 2013 to 2020. However, most emissions can be reduced annually by the establishment of a DECA that depends on the size of the control area and the fuel sulphur content limit. Costs range from 0.667 to 1.561 billion dollars (control regional shipping emissions) based on current fuel price. A social cost method shows the regional control scenarios benefit-cost ratios vary from 4.3 to 5.1 with large uncertainty. Chemical transportation model combined with health model method is used to get the monetary health benefits and then compared with the results from social cost method. This study suggests that Chinese DECAs will reduce the projected emissions at a favorable benefit-cost ratio, and furthermore proposes policy combinations that provide high cost-effective benefits as a reference for future policy-making. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

  7. Prevalence and cost of full-time research fellowships during general surgery residency: a national survey.

    Science.gov (United States)

    Robertson, Charles M; Klingensmith, Mary E; Coopersmith, Craig M

    2009-01-01

    To quantify the prevalence, outcomes, and cost of surgical resident research. General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1 to 3 years performing full-time research. No comprehensive data exists on the scope of this practice. Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Response rate was 200 of 239 (84%). A total of 381 of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and postresidency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (P < 0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of Accreditation Council for Graduate Medical Education work hour regulations for clinical residents, whereas a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. Although performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after postgraduate training.

  8. Marginal abatement cost curves in general equilibrium: The influence of world energy prices

    International Nuclear Information System (INIS)

    Klepper, Gernot; Peterson, Sonja

    2006-01-01

    Marginal abatement cost curves (MACCs) are a favorite instrument to analyze international emissions trading. This paper focuses on the question of how to define MACCs in a general equilibrium context where the global abatement level influences energy prices and in turn national MACCs. We discuss the mechanisms theoretically and then use the CGE model DART for quantitative simulations. The result is, that changes in energy prices resulting from different global abatement levels do indeed affect national MACCs. Also, we compare different possibilities of defining MACCs-of which some are robust against changes in energy prices while others vary considerably. (author)

  9. Negative royalty in duopoly and definition of license fee: general demand and cost functions

    OpenAIRE

    Hattori, Masahiko; Tanaka, Yasuhito

    2017-01-01

    We examine the relationship between the definition of license fee and a possibility of negative royalty in a duopoly with an outside innovator which has an option to enter the market and imposes a combination of a royalty per output and a fixed fee under general demand and cost functions. We consider two scenarios about determination of license fee. One is a scenario which does not assume entry of the innovator, and the other is a scenario which takes a possibility of entry of the innovator i...

  10. Prescription Patterns and the Cost of Migraine Treatments in German General and Neurological Practices.

    Science.gov (United States)

    Jacob, Louis; Kostev, Karel

    2017-07-01

    The aim of this study was to analyze prescription patterns and the cost of migraine treatments in general practices (GPs) and neurological practices (NPs) in Germany. This study included 43,149 patients treated in GPs and 13,674 patients treated in NPs who were diagnosed with migraine in 2015. Ten different families of migraine therapy were included in the analysis: triptans, analgesics, anti-emetics, beta-blockers, antivertigo products, gastroprokinetics, anti-epileptics, calcium channel blockers, tricyclic antidepressants, and other medications (all other classes used in the treatment of migraine including homeopathic medications). The share of migraine therapies and their costs were estimated for GPs and NPs. The mean age was 44.4 years in GPs and 44.1 years in NPs. Triptans and analgesics were the 2 most commonly prescribed families of drugs in all patients and in the 9 specific subgroups. Interestingly, triptans were more commonly prescribed in NPs than in GPs (30.9% to 55.0% vs. 30.0% to 44.7%), whereas analgesics were less frequently given in NPs than in GPs (11.5% to 17.2% vs. 35.3% to 42.4%). Finally, the share of patients who received no therapy was higher in NPs than in GPs (33.9% to 58.4% vs. 27.5% to 37.9%). The annual cost per patient was €66.04 in GPs and €94.71 in NPs. Finally, the annual cost per patient increased with age and was higher in women and in individuals with private health insurance coverage than in men and individuals with public health insurance coverage. Triptans and analgesics were the 2 most commonly prescribed drugs for the treatment of migraine. Furthermore, approximately 30% to 40% of patients did not receive any therapy. Finally, the annual cost per patient was higher in NPs than in GPs. © 2016 World Institute of Pain.

  11. General practitioner participation in intranatal care in the northern region in 1983.

    OpenAIRE

    Marsh, G N; Cashman, H A; Russell, I T

    1985-01-01

    In 1983 a quarter of general practitioners in the Northern region of England cared for obstetric deliveries and half of these for a minimum of 10 deliveries a year. Most expected their intranatal work to remain at the same level or increase in the next 10 years. Most participating general practitioners did their own forceps deliveries and initiated inductions. Most out of hours deliveries were attended by the mother's own general practitioner or a partner. A quarter of all respondents had car...

  12. Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil

    Directory of Open Access Journals (Sweden)

    de Oliveira Maria Regina F

    2012-11-01

    Full Text Available Abstract Background Rapid diagnostic tests (RDT for malaria have been demonstrated to be effective and they should replace microscopy in certain areas. Method The cost-effectiveness of five RDT and thick smear microscopy was estimated and compared. Data were collected on Brazilian Extra-Amazon Region. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, laboratory suppliers and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2010. Two costing methods were produced, based on exclusive-use microscopy or shared-use microscopy. The results were expressed in costs per adequately diagnosed cases in 2010 U.S. dollars. One-way sensitivity analysis was performed considering key model parameters. Results In the cost-effectiveness analysis with exclusive-use microscopy, the RDT CareStart™ was the most cost-effective diagnostic strategy. Microscopy was the most expensive and most effective, with an additional case adequately diagnosed by microscopy costing US$ 35,550.00 in relation to CareStart™. In opposite, in the cost-effectiveness analysis with shared-use microscopy, the thick smear was extremely cost-effective. Introducing into the analytic model with shared-use microscopy a probability for individual access to the diagnosis, assuming a probability of 100% of access for a public health system user to any RDT and, hypothetically, of 85% of access to microscopy, this test saw its effectiveness reduced and was dominated by the RDT CareStart™. Conclusion The analysis of cost-effectiveness of malaria diagnosis technologies in the Brazilian Extra-Amazon Region depends on the exclusive or shared use of the microscopy. Following the assumptions of this study, shared-use microscopy would be

  13. Generalized least squares and empirical Bayes estimation in regional partial duration series index-flood modeling

    DEFF Research Database (Denmark)

    Madsen, Henrik; Rosbjerg, Dan

    1997-01-01

    parameters is inferred from regional data using generalized least squares (GLS) regression. Two different Bayesian T-year event estimators are introduced: a linear estimator that requires only some moments of the prior distributions to be specified and a parametric estimator that is based on specified......A regional estimation procedure that combines the index-flood concept with an empirical Bayes method for inferring regional information is introduced. The model is based on the partial duration series approach with generalized Pareto (GP) distributed exceedances. The prior information of the model...

  14. Determination of chest x-ray cost using activity based costing approach at Penang General Hospital, Malaysia.

    Science.gov (United States)

    Atif, Muhammad; Sulaiman, Syed Azhar Syed; Shafie, Asrul Akmal; Saleem, Fahad; Ahmad, Nafees

    2012-01-01

    Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure. Human resource cost was calculated by multiplying the mean time spent by employees doing specific activity to their per-minute salaries. The costs of consumables and clinical equipments were obtained from the procurement section of the Radiology Department. The cost of the building was calculated by multiplying the area of space used by the chest X-ray facility with the unit cost of public building department. Moreover, straight-line deprecation with a discount rate of 3% was assumed for calculation of equivalent annual costs for building and machines. Cost of electricity was calculated by multiplying number of kilo watts used by electrical appliance in the year 2010 with electricity tariff for Malaysian commercial consumers (MYR 0.31 per kWh). Five activities were identified which were required to develop one chest X-ray film. Human resource, capital, consumable and electricity cost was MYR 1.48, MYR 1.98, MYR 2.15 and MYR 0.04, respectively. Total cost of single chest X-ray was MYR 5.65 (USD 1.75). By applying ABC approach, we can have more detailed and precise estimate of cost for specific activity or service. Choice of repeating a chest X-ray can be based on our findings, when cost is a limiting factor.

  15. Managing female urinary incontinence: A regional prospective analysis of cost-utility ratios (curs and effectiveness

    Directory of Open Access Journals (Sweden)

    Elisabetta Costantini

    2014-06-01

    Full Text Available Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81 were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS; Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life.

  16. General inspection strategy for fault diagnosis-minimizing the inspection costs

    International Nuclear Information System (INIS)

    Reinertsen, Rune; Wang Xiaozhong

    1995-01-01

    In this paper, a general inspection strategy for system fault diagnosis is presented. The procedure presented in this paper, is an improvement of methods described in papers by , and . This general strategy provides the optimal inspection procedure when the inspections require unequal effort and the minimum cut set probabilities are unequal. This feature makes the procedure described in this paper more useful for practical applications than the most recent procedure presented in the paper by Najmus-Saqib and Ishaque, which requires the minimum cut set probabilities to be equal. The inspection strategy described in this paper is based on first inspecting the basic event that will provide the maximum information gain per unit cost invested. The information gain is measured by the decrease of Shannon entropy. A detailed tutorial example is presented

  17. Message from the Director General Final costs to completion of LHC

    CERN Multimedia

    Luciano Maiani

    2001-01-01

    In March this year a review of the costs for the LHC machine was started, which was completed by the end of August. This was a bottom-up review with each group concerned making a projection of the cost to completion of the project. Figures presented were worryingly high. In conjunction, the responses from industries to the calls for tender for essential machine components, especially the superconducting magnet assembly, were also higher than originally anticipated. A summary of this situation was presented to the Finance Committee last week and then to the Committee of Council. After the meetings a summary was prepared by the chairman of Committee of Council which I reprint below. CHAIRMAN'S SUMMARY In the 248th Meeting of the Committee of Council, the Director-General presented a preliminary estimate of the cost to completion of the LHC Project, approved in 1994 and scheduled for commissioning and operation in 2006. Repeating that the project is well advanced and technically sound, the figures presented, s...

  18. A Generalized Minimum Cost Flow Model for Multiple Emergency Flow Routing

    Directory of Open Access Journals (Sweden)

    Jianxun Cui

    2014-01-01

    Full Text Available During real-life disasters, that is, earthquakes, floods, terrorist attacks, and other unexpected events, emergency evacuation and rescue are two primary operations that can save the lives and property of the affected population. It is unavoidable that evacuation flow and rescue flow will conflict with each other on the same spatial road network and within the same time window. Therefore, we propose a novel generalized minimum cost flow model to optimize the distribution pattern of these two types of flow on the same network by introducing the conflict cost. The travel time on each link is assumed to be subject to a bureau of public road (BPR function rather than a fixed cost. Additionally, we integrate contraflow operations into this model to redesign the network shared by those two types of flow. A nonconvex mixed-integer nonlinear programming model with bilinear, fractional, and power components is constructed, and GAMS/BARON is used to solve this programming model. A case study is conducted in the downtown area of Harbin city in China to verify the efficiency of proposed model, and several helpful findings and managerial insights are also presented.

  19. A Cost-based Explanation of Gradual, Regional Internationalization of Multinationals on Social Networking Sites

    DEFF Research Database (Denmark)

    Pogrebnyakov, Nicolai

    2017-01-01

    This paper examines firm internationalization on social networking sites (SNS). It systematically examines costs faced by an internationalizing firm and how firms react to these costs according to “distance-dependent” (gradual and regional) and “distance-invariant” (born-global) explanations...... of internationalization. Data on 5827 country pages of 240 multinational firms on Facebook, the most popular SNS today, is used. Creating a foreign country-specific Facebook page is considered the SNS equivalent of opening a physical subsidiary in that country. The data show that multinationals exhibit...

  20. Future regional nuclear fuel cycle cooperation in East Asia: Energy security costs and benefits

    International Nuclear Information System (INIS)

    Hippel, David von; Hayes, Peter; Kang, Jungmin; Katsuta, Tadahiro

    2011-01-01

    Economic growth in East Asia has rapidly increased regional energy, and especially, electricity needs. Many of the countries of East Asia have sought or are seeking to diversify their energy sources and bolster their energy supply and/or environmental security by developing nuclear power. Rapid development of nuclear power in East Asia brings with it concerns regarding nuclear weapons proliferation associated with uranium enrichment and spent nuclear fuel management. This article summarizes the development and analysis of four different scenarios of nuclear fuel cycle management in East Asia, including a scenario where each major nuclear power user develops uranium enrichment and reprocessing of spent fuel individually, scenarios featuring cooperation in the full fuel cycle, and a scenario where reprocessing is avoided in favor of dry cask storage of spent fuel. The material inputs and outputs and costs of key fuel cycle elements under each scenario are summarized. - Highlights: → We evaluate four scenarios of regional nuclear fuel cycle cooperation in East Asia and the Pacific. → The scenarios cover fuel supply, enrichment, transport, reprocessing, and waste management. → We evaluate nuclear material flows, energy use, costs, and qualitative energy security impacts. → Regional cooperation on nuclear fuel cycle issues can help to enhance energy security. → A regional scenario in which reprocessing is rapidly phased out shows security and cost advantages.

  1. Hanford general employee training: A million dollar cost-beneficial program

    International Nuclear Information System (INIS)

    Gardner, P.R.

    1991-01-01

    In January, 1990, Westinghouse Hanford Company (WHC) implemented an interactive videodisc training program entitled Hanford General Employee Training (HGET). Following an introduction by the course instructor, students begin the interactive video segment of the course by taking a tour of an office building. In fact, this tour is simply a setting in which to give the student a checkout on safety, security, and quality issues. For example, at one point the guide leaves the room and the phone suddenly begins a steady ring. This is a particular alarm at WHC, and the student is challenged to respond correctly. Missed questions flag corresponding tutorials to be delivered either immediately or on completion of the tour. Instructors receive notification of weakoesses left unremedied. Development costs for a sophisticated program such as HGET were high compared to similar costs for developing equivalent traditional training. Hardware and labor totaled $900K. Annual maintenance costs, equipment plus labor, appear to be running about $200K. On the benefit side, by consolidating some seventeen previous WHC courses and more effectively managing the instructional process, HGET reduced the average student training time from over eleven hours to just under four hours. In the development and implementation of HGET a number of issues were resolved, some more successfully than others: (1) what about job security for former instructors? (2) how should the course be run on a daily basis? (we envisioned a combination of instructor and videodisc); (3) how high will the maintenance costs be? (higher than projected); etc. Many obstacles arise, most in connection with the large number of groups and personnel whose efforts had to be coordinated

  2. “No generics, Doctor!” The perspective of general practitioners in two French regions

    Directory of Open Access Journals (Sweden)

    Béatrice Riner

    2017-11-01

    Full Text Available Abstract Background Generic medicines are essential to controlling health expenditures. Their market share is still small in France. The discourse and practices of prescribers may play a major role in their use. The purpose of this study was to explore the knowledge, attitudes and practices of general practitioners (GPs toward generic medicines in two French regions with the lowest penetration rate of these products. Methods An observational study was carried out from October 2015 to February 2016 in Guadeloupe and Martinique. The first qualitative phase involved a diversified sample of 14 GPs who underwent semi-structured interviews. The second phase involved a random sample of 316 GPs (response rate = 74% who were administered a structured questionnaire developed from the results of the first phase. Results Seventy-eight percent of the participants defined a generic drug as a drug containing an active substance identical to a brand-name drug, but only 11% considered generic drugs to be equivalent to brand-name drugs, and the same proportion believed that the generic drugs were of doubtful quality. The primary recognized advantage of generic medicines was their lower cost (82%. The main drawbacks cited were the variability of their presentation (44%, the confusion that they caused for some patients (47%, frequent allegations of adverse side effects (37% and a lack of efficacy (24%, and frequent refusal by patients (26%. Seventy-four percent of the participants stated that they adapted their prescribing practices to the situation, and of this group, 47% prescribed the originator product simply on demand. Conclusion Most surveyed GPs were not hostile towards generic medicines. They were caught between the requirements of health insurance regimes and the opposition of numerous users and suggested that the patient information provided by health authorities should be improved and that drug composition and packaging should be made uniform.

  3. Potential Cost Savings From Reduction of Regional Variation in Medicare Spending

    Directory of Open Access Journals (Sweden)

    Yunjie Song

    2016-04-01

    Full Text Available Potential cost savings estimated from reduction of regional variation in Medicare spending are considerable but questioned. This article evaluates the validity of the principal methods that have been used in the estimations of the potential savings. Three estimation approaches were identified. The first approach uses adjusted expenditures to calculate avoidable costs, but adjusted expenditures can be independent of avoidable costs, and measurement errors are not controlled. The second approach uses an outcome variable to replace its causal factors, and is not acceptable because the association between the outcomes and the causes is untestable. The final approach uses surveys to directly measure physician beliefs and patient preferences, but the sole study using this approach is weakened by sample selection biases and incomplete controls. A development of reliable measures and a switch of observation from clinic settings to geographic contexts could make the estimations more convincing.

  4. Assessing the Economic Cost of Landslide Damage in Low-Relief Regions: Case Study Evidence from the Flemish Ardennes (Belgium)

    Science.gov (United States)

    Vranken, L.; Van Turnhout, P.; Van Den Eeckhaut, M.; Vandekerckhove, L.; Vantilt, G.; Poesen, J.

    2012-04-01

    connecting two important Belgian cities has been built and within that one project, the cost to prevent damage to railroads augmented already to at least 4 567 822 €. The value of real estate located in regions affected by landslides decreased with 15% to 35%. All these damage costs were then used to made potential damage maps. Based on the inventory of landslides, frequency of landslides' re-activation and land use, we categorized regions that are affected by landslides according to their temporal probability of landslide re-activation. This allowed us to produce a (semi-) qualitative risk map for regions that were affected by landslides in the past. This paper shows that, though generally not spectacular, landsliding in low-relief regions susceptible to landslides is a slow but continuously operating process with considerable damage allowing one to identify several medium to high landslide risk zones. As such this study provides important information for government officials, especially those in charge of spatial planning and of town and environmental planning, as it clearly informs about the costs associated with certain land use types in landslide prone areas. This information can be particularly useful for regions in which increasing demand for building land pressures government officials and (local) political leaders to expand the built environment.

  5. An analysis of the 'costs and effectiveness' of post-mastectomy local-regional radiation therapy

    International Nuclear Information System (INIS)

    Marks, L.B.; Prosnitz, L.R.; Hardenbergh, P.H.; Winer, E.T.

    1997-01-01

    Purpose: To estimate the 'cost/effectiveness' ratio for post-mastectomy local-regional radiation therapy (LR-XRT) for patients with breast cancer. As the risk of local-regional recurrence (LRR) is related to the number of positive axillary lymph nodes, the cost/effectiveness ratio of LR-XRT was assessed for a variable number of positive axillary nodes. For overall survival (OS), the cost per additional life-year is estimated as a function of follow-up duration. Methods/Assumptions: Literature data indicate that the risk of LRR is related to the number of positive axillary nodes (e.g. Fowble, Kuske). For example, the LRR rate is ∼10% for patients with negative nodes, increasing to ∼40% for patients with ≥4 positive nodes. Such data are used to linearly relate the number of positive nodes with the risk of LRR. Additional assumptions include: RT reduces the risk of LRR by 67%; local recurrences are treated with exision/biopsy, LR-XRT and systemic chemotherapy; half of the local recurrences are controlled locally and half will require additional salvage treatment with surgery or chemotherapy. The 5, 10 and 15 yr improvements in OS provided by LR-XRT are estimated to be 3, 7, and 10%, respectively, based on the literature (Overgaard, Ragaz, Klefstrom, Rutqvist). For each year following LR-XRT, the accrued life-years gained are estimated from the published survival curves. Professional and technical charges are used as a surrogate for costs, as follows (in thousands): LR-XRT-15; evaluation of recurrence-2; biopsy plus pathology-1; resection plus pathology-7, chemotherapy-10. Results: The cost per LRR prevented with the addition of routine post-mastectomy LR-XRT is shown, as a function of the number of positive axillary nodes. The cost per additional life-year gained with LR-XRT, as a function of follow-up duration, is shown. With increasing follow-up, the cost per life-year gained decreases as the additional life-years accrue. Conclusions: The cost per LRR

  6. Accurate Computation of Periodic Regions' Centers in the General M-Set with Integer Index Number

    Directory of Open Access Journals (Sweden)

    Wang Xingyuan

    2010-01-01

    Full Text Available This paper presents two methods for accurately computing the periodic regions' centers. One method fits for the general M-sets with integer index number, the other fits for the general M-sets with negative integer index number. Both methods improve the precision of computation by transforming the polynomial equations which determine the periodic regions' centers. We primarily discuss the general M-sets with negative integer index, and analyze the relationship between the number of periodic regions' centers on the principal symmetric axis and in the principal symmetric interior. We can get the centers' coordinates with at least 48 significant digits after the decimal point in both real and imaginary parts by applying the Newton's method to the transformed polynomial equation which determine the periodic regions' centers. In this paper, we list some centers' coordinates of general M-sets' k-periodic regions (k=3,4,5,6 for the index numbers α=−25,−24,…,−1 , all of which have highly numerical accuracy.

  7. Reforming the Canadian Sales Tax System: A Regional General Equilibrium Analysis

    OpenAIRE

    CHUN-YAN KUO; BOB HAMILTON

    1991-01-01

    The paper develops a regional general equilibrium model of the Canadian economy to analyze the sectoral and regional impacts of the major changes to the Canadian sales tax system. The results indicate that replacing the federal sales tax with the goods and service tax increases real output in Canada in the long run by 1.4 percent. If the provincial sales taxes are also integrated, real output increases by a further 0.8 percent.

  8. Costs and expected gain in lifetime health from intensive care versus general ward care of 30,712 individual patients: a distribution-weighted cost-effectiveness analysis.

    Science.gov (United States)

    Lindemark, Frode; Haaland, Øystein A; Kvåle, Reidar; Flaatten, Hans; Norheim, Ole F; Johansson, Kjell A

    2017-08-21

    Clinicians, hospital managers, policy makers, and researchers are concerned about high costs, increased demand, and variation in priorities in the intensive care unit (ICU). The objectives of this modelling study are to describe the extra costs and expected health gains associated with admission to the ICU versus the general ward for 30,712 patients and the variation in cost-effectiveness estimates among subgroups and individuals, and to perform a distribution-weighted economic evaluation incorporating extra weighting to patients with high severity of disease. We used a decision-analytic model that estimates the incremental cost per quality-adjusted life year (QALY) gained (ICER) from ICU admission compared with general ward care using Norwegian registry data from 2008 to 2010. We assigned increasing weights to health gains for those with higher severity of disease, defined as less expected lifetime health if not admitted. The study has inherent uncertainty of findings because a randomized clinical trial comparing patients admitted or rejected to the ICU has never been performed. Uncertainty is explored in probabilistic sensitivity analysis. The mean cost-effectiveness of ICU admission versus ward care was €11,600/QALY, with 1.6 QALYs gained and an incremental cost of €18,700 per patient. The probability (p) of cost-effectiveness was 95% at a threshold of €22,000/QALY. The mean ICER for medical admissions was €10,700/QALY (p = 97%), €12,300/QALY (p = 93%) for admissions after acute surgery, and €14,700/QALY (p = 84%) after planned surgery. For individualized ICERs, there was a 50% probability that ICU admission was cost-effective for 85% of the patients at a threshold of €64,000/QALY, leaving 15% of the admissions not cost-effective. In the distributional evaluation, 8% of all patients had distribution-weighted ICERs (higher weights to gains for more severe conditions) above €64,000/QALY. High-severity admissions gained the most, and were more

  9. Regional differences of outpatient physician supply as a theoretical economic and empirical generalized linear model.

    Science.gov (United States)

    Scholz, Stefan; Graf von der Schulenburg, Johann-Matthias; Greiner, Wolfgang

    2015-11-17

    Regional differences in physician supply can be found in many health care systems, regardless of their organizational and financial structure. A theoretical model is developed for the physicians' decision on office allocation, covering demand-side factors and a consumption time function. To test the propositions following the theoretical model, generalized linear models were estimated to explain differences in 412 German districts. Various factors found in the literature were included to control for physicians' regional preferences. Evidence in favor of the first three propositions of the theoretical model could be found. Specialists show a stronger association to higher populated districts than GPs. Although indicators for regional preferences are significantly correlated with physician density, their coefficients are not as high as population density. If regional disparities should be addressed by political actions, the focus should be to counteract those parameters representing physicians' preferences in over- and undersupplied regions.

  10. General practitioner participation in intranatal care in the northern region in 1983.

    Science.gov (United States)

    Marsh, G N; Cashman, H A; Russell, I T

    1985-03-30

    In 1983 a quarter of general practitioners in the Northern region of England cared for obstetric deliveries and half of these for a minimum of 10 deliveries a year. Most expected their intranatal work to remain at the same level or increase in the next 10 years. Most participating general practitioners did their own forceps deliveries and initiated inductions. Most out of hours deliveries were attended by the mother's own general practitioner or a partner. A quarter of all respondents had cared for planned and unplanned home births. Few were happy about attending them, but most would provide planned home care if urged to do so.

  11. A General Method to Estimate Earthquake Moment and Magnitude using Regional Phase Amplitudes

    Energy Technology Data Exchange (ETDEWEB)

    Pasyanos, M E

    2009-11-19

    This paper presents a general method of estimating earthquake magnitude using regional phase amplitudes, called regional M{sub o} or regional M{sub w}. Conceptually, this method uses an earthquake source model along with an attenuation model and geometrical spreading which accounts for the propagation to utilize regional phase amplitudes of any phase and frequency. Amplitudes are corrected to yield a source term from which one can estimate the seismic moment. Moment magnitudes can then be reliably determined with sets of observed phase amplitudes rather than predetermined ones, and afterwards averaged to robustly determine this parameter. We first examine in detail several events to demonstrate the methodology. We then look at various ensembles of phases and frequencies, and compare results to existing regional methods. We find regional M{sub o} to be a stable estimator of earthquake size that has several advantages over other methods. Because of its versatility, it is applicable to many more events, particularly smaller events. We make moment estimates for earthquakes ranging from magnitude 2 to as large as 7. Even with diverse input amplitude sources, we find magnitude estimates to be more robust than typical magnitudes and existing regional methods and might be tuned further to improve upon them. The method yields a more meaningful quantity of seismic moment, which can be recast as M{sub w}. Lastly, it is applied here to the Middle East region using an existing calibration model, but it would be easy to transport to any region with suitable attenuation calibration.

  12. Performing an Environmental Tax Reform in a regional Economy. A Computable General Equilibrium

    NARCIS (Netherlands)

    Andre, F.J.; Cardenete, M.A.; Velazquez, E.

    2003-01-01

    We use a Computable General Equilibrium model to simulate the effects of an Environmental Tax Reform in a regional economy (Andalusia, Spain).The reform involves imposing a tax on CO2 or SO2 emissions and reducing either the Income Tax or the payroll tax of employers to Social Security, and

  13. Indirect cost of maternal deaths in the WHO African Region in 2010.

    Science.gov (United States)

    Kirigia, Joses Muthuri; Mwabu, Germano Mwige; Orem, Juliet Nabyonga; Muthuri, Rosenabi Deborah Karimi

    2014-08-31

    An estimated 147,741 maternal deaths occurred in 2010 in 45 of the 47 countries in the African Region of the World Health Organization (WHO). The objective of this study was to estimate the indirect cost of maternal deaths in the Region to provide data for use in advocacy for increased domestic and external investment in multisectoral policy interventions to curb maternal mortality. This study used the cost-of-illness method to estimate the indirect cost of maternal mortality, i.e. the loss in non-health gross domestic product (GDP) attributable to maternal deaths. Estimates on maternal mortality for 2010 from Trends in maternal mortality: 1990 to 2010 published by WHO, UNICEF, UNFPA and the World Bank were used in these calculations. Values for future non-health GDP lost were converted into their present values by applying a 3% discount rate. One-way sensitivity analysis at 5% and 10% discount rates assessed the impact on non-health GDP loss. Indirect cost analysis was undertaken for the countries, categorized under three income groups. Group 1 consisted of nine high and upper middle income countries, Group 2 of 12 lower middle income countries, and Group 3 of 26 low income countries. Estimates for Seychelles in Group 1 and South Sudan in Group 3 were not provided in the source used. The 147,741 maternal deaths that occurred in 45 countries in the African Region in 2010 resulted in a total non-health GDP loss of Int$ 4.5 billion (PPP). About 24.5% of the loss was in Group 1 countries, 44.9% in Group 2 countries and 30.6% in Group 3 countries. This translated into losses in non-health GDP of Int$ 139,219, Int$ 35,440 and Int$ 16,397 per maternal death, respectively, for the three groups. Using discount rates of 5% and 10% reduced the total non-health GDP loss by 19.1% and 47.7%, respectively. Maternal mortality is responsible for a noteworthy level of non-health GDP loss among the countries in the African Region. There is urgent need, therefore, to increase

  14. STUDI BANDING PENYUSUNAN LAPORAN KEUANGAN DENGAN METODE HISTORICAL COST ACCOUNTING DAN GENERAL PRICE LEVEL ACCOUNTING PADA MASA INFLASI

    Directory of Open Access Journals (Sweden)

    David Sukardi Kodrat

    2006-01-01

    Full Text Available Generally, Financial Statements are based on Historical Cost Accounting (HCA that assumes that prices are stable. Actually, there are several methods on accounting for the effect of changing prices, such as Current Cost Accounting (Replacement Cost Accounting and Constant Dollar Accounting or General Price Level Accounting (GPLA. GPLA will do restatement the components of financial statement to be a rupiah on a similar level of purchasing power, but without changes in accounting principles which using on conventional accounting. Financial statements made by GPLA are comparing to financial statements made by HCA. Both of financial statements are analysis with NOD (Number of Dollar attribute to know that financial statements are interpretative and analysis with COG (Command of Good attribute to know that financial statements are relevant. Abstract in Bahasa Indonesia : Laporan keuangan disusun berdasarkan metode Historical Cost Accounting (HCA yang menggunakan asumsi nilai tukar stabil. Beberapa metode akuntansi yang memperhitungkan perubahan nilai tukar seperti Current Cost Accounting (Replacement Cost Accounting dan Constant Dollar Accounting atau General Price Level Accounting (GPLA. GPLA menyajikan komponen laporan keuangan berdasarkan penyesuaian rupiah dengan daya beli tanpa mengubah prinsip-prinsip akuntasi konvensional. Laporan keuangan yang disusun dengan GPLA dapat diperbandingkan dengan laporan keuangan berdasarkan HCA. Dengan analisa NOD (Number of Dollar dan COG (Command Over Good attribute menunjukkan bahwa laporan keuangan berdasarkan GPLA lebih interpretatif dan lebih relevan. Kata Kunci: Laporan Keuangan, Historical Cost Accounting, General Price Level Accounting, NOD attribute, COG attribute.

  15. Vertical integration of teaching in Australian general practice--a survey of regional training providers.

    Science.gov (United States)

    Stocks, Nigel P; Frank, Oliver; Linn, Andrew M; Anderson, Katrina; Meertens, Sarah

    2011-06-06

    To examine vertical integration of teaching and clinical training in general practice and describe practical examples being undertaken by Australian general practice regional training providers (RTPs). A qualitative study of all RTPs in Australia, mid 2010. All 17 RTPs in Australia responded. Eleven had developed some vertical integration initiatives. Several encouraged registrars to teach junior doctors and medical students, others encouraged general practitioner supervisors to run multilevel educational sessions, a few coordinated placements, linkages and support across their region. Three RTPs provided case studies of vertical integration. Many RTPs in Australia use vertical integration of teaching in their training programs. RTPs with close associations with universities and rural clinical schools seem to be leading these initiatives.

  16. Regional or general anesthesia for fast-track hip and knee replacement - what is the evidence?

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Aasvang, Eske Kvanner

    2015-01-01

    Regional anesthesia for knee and hip arthroplasty may have favorable outcome effects compared with general anesthesia by effectively blocking afferent input, providing initial postoperative analgesia, reducing endocrine metabolic responses, and providing sympathetic blockade with reduced bleeding...... and less risk of thromboembolic complications but with undesirable effects on lower limb motor and urinary bladder function. Old randomized studies supported the use of regional anesthesia with fewer postoperative pulmonary and thromboembolic complications, and this has been supported by recent large non......-randomized epidemiological database cohort studies. In contrast, the data from newer randomized trials are conflicting, and recent studies using modern general anesthetic techniques may potentially support the use of general versus spinal anesthesia. In summary, the lack of properly designed large randomized controlled...

  17. A general approach to regularizing inverse problems with regional data using Slepian wavelets

    Science.gov (United States)

    Michel, Volker; Simons, Frederik J.

    2017-12-01

    Slepian functions are orthogonal function systems that live on subdomains (for example, geographical regions on the Earth’s surface, or bandlimited portions of the entire spectrum). They have been firmly established as a useful tool for the synthesis and analysis of localized (concentrated or confined) signals, and for the modeling and inversion of noise-contaminated data that are only regionally available or only of regional interest. In this paper, we consider a general abstract setup for inverse problems represented by a linear and compact operator between Hilbert spaces with a known singular-value decomposition (svd). In practice, such an svd is often only given for the case of a global expansion of the data (e.g. on the whole sphere) but not for regional data distributions. We show that, in either case, Slepian functions (associated to an arbitrarily prescribed region and the given compact operator) can be determined and applied to construct a regularization for the ill-posed regional inverse problem. Moreover, we describe an algorithm for constructing the Slepian basis via an algebraic eigenvalue problem. The obtained Slepian functions can be used to derive an svd for the combination of the regionalizing projection and the compact operator. As a result, standard regularization techniques relying on a known svd become applicable also to those inverse problems where the data are regionally given only. In particular, wavelet-based multiscale techniques can be used. An example for the latter case is elaborated theoretically and tested on two synthetic numerical examples.

  18. Domain-General Brain Regions Do Not Track Linguistic Input as Closely as Language-Selective Regions.

    Science.gov (United States)

    Blank, Idan A; Fedorenko, Evelina

    2017-10-11

    Language comprehension engages a cortical network of left frontal and temporal regions. Activity in this network is language-selective, showing virtually no modulation by nonlinguistic tasks. In addition, language comprehension engages a second network consisting of bilateral frontal, parietal, cingulate, and insular regions. Activity in this "multiple demand" (MD) network scales with comprehension difficulty, but also with cognitive effort across a wide range of nonlinguistic tasks in a domain-general fashion. Given the functional dissociation between the language and MD networks, their respective contributions to comprehension are likely distinct, yet such differences remain elusive. Prior neuroimaging studies have suggested that activity in each network covaries with some linguistic features that, behaviorally, influence on-line processing and comprehension. This sensitivity of the language and MD networks to local input characteristics has often been interpreted, implicitly or explicitly, as evidence that both networks track linguistic input closely, and in a manner consistent across individuals. Here, we used fMRI to directly test this assumption by comparing the BOLD signal time courses in each network across different people ( n = 45, men and women) listening to the same story. Language network activity showed fewer individual differences, indicative of closer input tracking, whereas MD network activity was more idiosyncratic and, moreover, showed lower reliability within an individual across repetitions of a story. These findings constrain cognitive models of language comprehension by suggesting a novel distinction between the processes implemented in the language and MD networks. SIGNIFICANCE STATEMENT Language comprehension recruits both language-specific mechanisms and domain-general mechanisms that are engaged in many cognitive processes. In the human cortex, language-selective mechanisms are implemented in the left-lateralized "core language network

  19. Improving the Quality of the Deteriorated Regions of Multicrystalline Silicon Ingots during General Solar Cell Processes

    International Nuclear Information System (INIS)

    Wu Shan-Shan; Wang Lei; Yang De-Ren

    2011-01-01

    The behavior of wafers and solar cells from the border of a multicrystalline silicon (mc-Si) ingot, which contain deteriorated regions, is investigated. It is found that the diffusion length distribution of minority carriers in the cells is uniform, and high efficiency of the solar cells (about 16%) is achieved. It is considered that the quality of the deteriorated regions could be improved to be similar to that of adjacent regions. Moreover, it is indicated that during general solar cell fabrication, phosphorus gettering and hydrogen passivation could significantly improve the quality of deteriorated regions, while aluminum gettering by RTP could not. Therefore, it is suggested that the border of a mc-Si ingot could be used to fabricate high efficiency solar cells, which will increase mc-Si utilization effectively. (condensed matter: structure, mechanical and thermal properties)

  20. Initial investigation into lower-cost CT for resource limited regions of the world

    Science.gov (United States)

    Dobbins, James T., III; Wells, Jered R.; Segars, W. Paul; Li, Christina M.; Kigongo, Christopher J. N.

    2010-04-01

    This paper describes an initial investigation into means for producing lower-cost CT scanners for resource limited regions of the world. In regions such as sub-Saharan Africa, intermediate level medical facilities serving millions have no CT machines, and lack the imaging resources necessary to determine whether certain patients would benefit from being transferred to a hospital in a larger city for further diagnostic workup or treatment. Low-cost CT scanners would potentially be of immense help to the healthcare system in such regions. Such scanners would not produce state-of-theart image quality, but rather would be intended primarily for triaging purposes to determine the patients who would benefit from transfer to larger hospitals. The lower-cost scanner investigated here consists of a fixed digital radiography system and a rotating patient stage. This paper describes initial experiments to determine if such a configuration is feasible. Experiments were conducted using (1) x-ray image acquisition, a physical anthropomorphic chest phantom, and a flat-panel detector system, and (2) a computer-simulated XCAT chest phantom. Both the physical phantom and simulated phantom produced excellent image quality reconstructions when the phantom was perfectly aligned during acquisition, but artifacts were noted when the phantom was displaced to simulate patient motion. An algorithm was developed to correct for motion of the phantom and demonstrated success in correcting for 5-mm motion during 360-degree acquisition of images. These experiments demonstrated feasibility for this approach, but additional work is required to determine the exact limitations produced by patient motion.

  1. Regional-employment impact of rapidly escalating energy costs. [Riverside-San Bernardino SMSA

    Energy Technology Data Exchange (ETDEWEB)

    Kolk, D X

    1983-04-01

    This paper presents a methodology for incorporating price-induced technological substitution into a regional input-output forecasting model. The model was used to determine the employment impacts of rapidly escalating energy costs on the Riverside-San Bernardino (California) SMSA. The results indicate that the substitution effect between energy and other goods was dominated by the income effect. A reallocation of consumer expenditures from labor-intensive to energy-intensive goods occurred, resulting in a two- to threefold increase in the unemployment rate among low-skilled individuals. 18 references, 5 tables.

  2. Regional cost-effectiveness in transboundary water quality management for the Baltic Sea

    DEFF Research Database (Denmark)

    Hasler, Berit; Smart, James Christopher Rudd; Fonnesbech-Wulff, Anders

    In 2007 HELCOM launched a plan for transboundary management of the Baltic Sea. This plan, called the Baltic Sea Action Plan (BSAP), aims amongst other things, to reduce eutrophication in the different regions of the Baltic Sea by reducing incoming nutrient loads from all discharging drainage basins...... difficult to achieve, and that additional abatement measures are likely to be required to fulfil these targets. The minimised total cost of delivering the achievable load reductions across the 9 Baltic littoral countries is estimated to be 4.69 billion Euros, annually, with substantial differences...

  3. Liquefied Natural Gas as an alternative fuel: a regional-level social cost-benefit appraisal

    OpenAIRE

    Moreira, Paulo Pires; Caetano, Fernando J. P.

    2017-01-01

    The impact from traditional marine fuels has the potential of causing health and non-health damages and contributes to climate change. Here, the introduction of Liquefied Natural Gas (LNG) as an energy end-use fuel for marine purposes is analysed. The aim of this study is to verify LNG’s policy implementation feasibility as a step-change for a low carbon perspective for shipping by means of developing a social cost-benefit analysis on a regional basis. Emissions from the Portuguese merchant f...

  4. Cost of near-roadway and regional air pollution-attributable childhood asthma in Los Angeles County

    Science.gov (United States)

    Brandt, Sylvia; Perez, Laura; Künzli, Nino; Lurmann, Fred; Wilson, John; Pastor, Manuel; McConnell, Rob

    2014-01-01

    Background Emerging evidence suggests that near-roadway air pollution (NRP) exposure causes childhood asthma. Associated costs are not well documented. Objective We estimated the cost of childhood asthma attributable to residential NRP exposure and regional ozone (O3) and nitrogen dioxide (NO2) in Los Angeles County. We developed a novel approach to apportion the costs between these exposures under different pollution scenarios. Methods We integrated results from a study of willingness to pay to reduce the burden of asthma with studies of health care utilization and charges to estimate the costs of an asthma case and exacerbation. We applied those costs to the number of asthma cases and exacerbations due to regional pollution in 2007 and to hypothetical scenarios of a 20% reduction in regional pollution in combination with a 20% reduction or increase in the proportion of the total population living within 75m of a major roadway. Results Cost of air pollution-related asthma in Los Angeles County in 2007 was $441 million for O3 and $202 million for NO2 in 2010 dollars. Cost of routine care (care in absence of exacerbation) accounted for 18% of the combined NRP and O3 cost and 39% of the combined NRP and NO2 cost—costs not recognized in previous analyses. NRP-attributable asthma accounted for 43% (O3) to 51% (NO2) of the total annual cost of exacerbations and routine care associated with pollution. Hypothetical scenarios showed that costs from increased NRP exposure may offset savings from reduced regional pollution. Conclusions Our model disaggregates the costs of regional pollution and NRP exposure and illustrates how they might vary under alternative exposure scenarios. The cost of air pollution is a substantial burden on families and an economic loss for society. PMID:25439228

  5. Generalized hedgehog ansatz and Gribov copies in regions with nontrivial topologies

    Science.gov (United States)

    Canfora, Fabrizio; Salgado-Rebolledo, Patricio

    2013-02-01

    In this paper the arising of Gribov copies both in Landau and Coulomb gauges in regions with nontrivial topologies but flat metric, (such as closed tubes S1×D2, or R×T2) will be analyzed. Using a novel generalization of the hedgehog ansatz beyond spherical symmetry, analytic examples of Gribov copies of the vacuum will be constructed. Using such ansatz, we will also construct the elliptic Gribov pendulum. The requirement of absence of Gribov copies of the vacuum satisfying the strong boundary conditions implies geometrical constraints on the shapes and sizes of the regions with nontrivial topologies.

  6. Low-cost general purpose spectral display unit using an IBM PC

    International Nuclear Information System (INIS)

    Robinson, S.L.

    1985-10-01

    Many physics experiments require acquisition and analysis of spectral data. commercial minicomputer-based multichannel analyzers collect detected counts at various energies, create a histogram of the counts in memory, and display the resultant spectra. They acquire data and provide the user-to-display interface. The system discussed separates functions into the three modular components of data acquisition, storage, and display. This decoupling of functions allows the experimenter to use any number of detectors for data collection before forwarding up to 64 spectra to the display unit, thereby increasing data throughput over that available with commercial systems. An IBM PC was chosen for the low-cost, general purpose display unit. Up to four spectra may be displayed simultaneously in different colors. The histogram saves 1024 channels per detector, 640 of which may be distinctly displayed per spectra. The IEEE-488 standard provides the data path between the IBM PC and the data collection unit. Data is sent to the PC under interrupt control, using direct memory access. Display manipulations available via keyboard are also discussed

  7. A General Catalytic Method for Highly Cost- and Atom-Efficient Nucleophilic Substitutions.

    Science.gov (United States)

    Huy, Peter H; Filbrich, Isabel

    2018-05-23

    A general formamide-catalyzed protocol for the efficient transformation of alcohols into alkyl chlorides, which is promoted by substoichiometric amounts (down to 34 mol %) of inexpensive trichlorotriazine (TCT), is introduced. This is the first example of a TCT-mediated dihydroxychlorination of an OH-containing substrate (e.g., alcohols and carboxylic acids) in which all three chlorine atoms of TCT are transferred to the starting material. The consequently enhanced atom economy facilitates a significantly improved waste balance (E-factors down to 4), cost efficiency, and scalability (>50 g). Furthermore, the current procedure is distinguished by high levels of functional-group compatibility and stereoselectivity, as only weakly acidic cyanuric acid is released as exclusive byproduct. Finally, a one-pot protocol for the preparation of amines, azides, ethers, and sulfides enabled the synthesis of the drug rivastigmine with twofold S N 2 inversion, which demonstrates the high practical value of the presented method. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  8. A low-cost general purpose spectral display unit using an IBM PC

    International Nuclear Information System (INIS)

    Robinson, S.L.

    1986-01-01

    Many physics experiments require acquisition and analysis of spectral data. Commercial minicomputer-based multichannel analyzers collect detected counts at various energies, create a histogram of the counts in memory, and display the resultant spectra. They acquire data and provide the user-to-display interface. The system discussed separates functions into the three modular components of data acquisition, storage, and display. This decoupling of functions allows the experimenter to use any number of detectors for data collection before forwarding up to 64 spectra to the display unit, thereby increasing data throughput over that available with commercial systems. An IBM PC was chosen for the low-cost, general purpose display unit. Up to four spectra may be displayed simultaneously in different colors. The histogram saves 1024 channels per detector, 640 of which may be distinctly displayed per spectra. The IEEE-488 standard provides the data path between the IBM PC and the data collection unit. Data is sent to the PC under interrupt control, using direct memory access. Display manipulations available via keyboard are also discussed

  9. Development of Innovative Technology to Provide Low-Cost Surface Atmospheric Observations in Data Sparse Regions

    Science.gov (United States)

    Kucera, Paul; Steinson, Martin

    2017-04-01

    Accurate and reliable real-time monitoring and dissemination of observations of surface weather conditions is critical for a variety of societal applications. Applications that provide local and regional information about temperature, precipitation, moisture, and winds, for example, are important for agriculture, water resource monitoring, health, and monitoring of hazard weather conditions. In many regions of the World, surface weather stations are sparsely located and/or of poor quality. Existing stations have often been sited incorrectly, not well-maintained, and have limited communications established at the site for real-time monitoring. The University Corporation for Atmospheric Research (UCAR)/National Center for Atmospheric Research (NCAR), with support from USAID, has started an initiative to develop and deploy low-cost weather instrumentation in sparsely observed regions of the world. The project is focused on improving weather observations for environmental monitoring and early warning alert systems on a regional to global scale. Instrumentation that has been developed use innovative new technologies such as 3D printers, Raspberry Pi computing systems, and wireless communications. The goal of the project is to make the weather station designs, software, and processing tools an open community resource. The weather stations can be built locally by agencies, through educational institutions, and residential communities as a citizen effort to augment existing networks to improve detection of natural hazards for disaster risk reduction. The presentation will provide an overview of the open source weather station technology and evaluation of sensor observations for the initial networks that have been deployed in Africa.

  10. TRANSACTION COSTS WITHIN THE INDIVIDUAL AND COOPERATIVE APPLE PRODUCERS IN PRESPA REGION, THE REPUBLIC OF MACEDONIA

    Directory of Open Access Journals (Sweden)

    Aleksandra ANGELOSKA

    2018-02-01

    Full Text Available Apple production in the Republic of Macedonia is an important sector that highly contributes to theeconomy in terms of employment and income, especially for the small farmers in Prespa Region. Despitecooperatives’ efforts and governmental support to attract members through the provision of inputs,technical advices and other incentives to farmers, membership adherence is low and slow. The TransactionCost Economics Theory (TCE provided the basis for this study where the choice is conditioned by relativecomparative advantage in terms of lower transaction costs. Based on the research, following conclusions are underlined: a. from the perspective of farmers andthe cooperatives there are factors that positively influence the choice of cooperative membership; b. fromthe cooperative’s side, some of the positive influences are its regular flow of price information, constanttechnical advices and secured market; c for farmers who aim at increasing production and improving theirincomes, membership to cooperative signifies security of accessing cheaper inputs especially chemicalfertiliser, security of market for the produced apples and higher frequency of transaction cost. Farmers’choices are not exclusive to one type of structure or the other. Farmers can transact with the cooperative andtrader at the same time, influenced by the differences in the price among the “Idared” and “varieties”. Bothof them, members and non-members are limited connected to the “middlemen” in choice of transactions.

  11. Automotive Lithium-ion Cell Manufacturing: Regional Cost Structures and Supply Chain Considerations

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Donald [Clean Energy Manufacturing Analysis Center, Godlen, CO (United States); Elgqvist, Emma [Clean Energy Manufacturing Analysis Center, Godlen, CO (United States); Santhanagopalan, Shriram [Clean Energy Manufacturing Analysis Center, Godlen, CO (United States)

    2016-04-08

    Manufacturing capacity for lithium-ion batteries (LIBs)--which power many consumer electronics and are increasingly used to power electric vehicles--is heavily concentrated in east Asia. Currently, China, Japan, and Korea collectively host 88% of all LIB cell and 79% of automotive LIB cell manufacturing capacity. Mature supply chains and strong cumulative production experience suggest that most LIB cell production will remain concentrated in Asia. However, other regions--including North America--could be competitive in the growing automotive LIB cell market under certain conditions. To illuminate the factors that drive regional competitiveness in automotive LIB cell production, this study models cell manufacturing cost and minimum sustainable price, and examines development of LIB supply chains and current LIB market conditions. Modeled costs are for large format, 20-Ah stacked pouch cells with lithium-nickel-manganese-cobalt-oxide (NMC) cathodes and graphite anodes suitable for automotive application. Production volume is assumed to be at commercial scale, 600 MWh per year.

  12. Clean air benefits and costs in the GVRD [Greater Vancouver Regional District

    International Nuclear Information System (INIS)

    Gislason, G.; Martin, J.; Williams, D.; Caton, B.; Rich, J.; Rojak, S.; Robinson, J.; Stuermer, A. von

    1994-01-01

    Air pollution is a major concern in the Greater Vancouver Regional District in British Columbia. An analysis was conducted to assess the costs and benefits of an innovative plan to reduce the emissions of five primary pollutants in the GVRD: nitrogen oxides (NOx), sulfur oxides (SOx), volatile organic compounds (VOCs), particulates, and CO. The study adopts a damage function approach in which the benefits of reduced emissions are given by the averted damages to human health, crops, and so on. Under a base case scenario, motor vehicle emission controls and additional measures proposed in the region's air quality management plan (AQMP) are projected to lead to emission reductions of 873,000 tonnes in the GVRD by the year 2020, compared to the emission level projected without intervention. The AQMP is projected to avert over its life some 2,800 premature deaths, 33,000 emergency room visits, 13 million restricted activity days, and 5 million symptoms. Crop losses due to ozone are projected to decrease by 1-4%/y over the next several decades due to the AQMP. Damage averted to materials and property per tonne of pollutant reduced ranges from $30 for VOC to $180 for particulates. Under base-case conservative assumptions, the AQMP generates $5.4 billion in benefits and $3.8 billion in costs, nearly 2/3 of which are paid by the industrial and commercial sectors. 1 tab

  13. HISTORIOGRAPHY GENERAL, REGIONAL AND SPECIAL STUDIES OF JUDICIAL REFORM IN RUSSIA 1864

    Directory of Open Access Journals (Sweden)

    Sergei Evgenievich Strakhov

    2014-10-01

    Full Text Available In today's world, a crucial role is played by the judiciary. In the period lasting judicial reform, it is important to explore this institution not only at the present stage, but also to trace the history of its development, including - through analysis and synthesis of existing studies of the judiciary and judicial reforms.The purpose of this study - to explore the historiography of general, special and regional studies of judicial reform of1864 inRussia, to classify research on history and on the subject of the study.Scientific, theoretical and practical significance of the work lies in the fact that the study of this topic will summarize the significant weight of the studies of the judicial reform of 1864 and classified by facilitating orientation interested in individuals in the study subjects.The author uses historical, comparative, hermeneutical, mathematical methods, as well as general methods of scientific research.The author analyzes the historiography of general, special and regional studies of the judicial reform of1864 inRussia, introducing a classification of such studies in chronological order (pre-revolutionary, Soviet and modern stages and subject matter (common - affecting all aspects of judicial reform, special - dedicated to a particular aspect (legal agencies, prosecutors, legal, etc. and regional - dedicated to judicial reform, or some aspects of it in some regions of Russia.The results of this study are scientific and practical value, because they can be useful for teaching students - in industry disciplines "judiciary", "advocacy", "notary public", "public prosecutor's supervision" and general theoretical "History of State and Law," "History of the fatherland" ; in science - by picking up information about the historiography of the judicial reform, and in practice - said work can serve as a guide to research judicial reform, which may be useful to practitioners of judicial and investigative bodies, as well as - prosecutors

  14. The generalized model of organization and planning of regional gas supply monitoring

    Directory of Open Access Journals (Sweden)

    Maria V. Shevchenko

    2015-12-01

    Full Text Available At the moment, gas is one of the most promising types of fuel in Ukraine. In this regard, the problems associated with its transportation in the regional system of gas supply are relevant. Now it is not completely solved and needs detailed study the problem of monitoring the regional gas supply system. Aim: The aim of the study is to improve the efficiency of the regional gas supply system at the expense of the organization and planning of gas transport monitoring and, in the future, the synthesis of the monitoring system of regional gas supply. Materials and Methods: The generalized model of organization and planning of monitoring regional gas suppliers were developed to achieve this goal. It allows making decisions on the organization of the monitoring system. In addition, this model makes it possible to plan under conditions of multicriteriality and uncertainty of the source data. Results: The basic criteria and constraints for solving the problem of organizing and planning the monitoring system of regional gas supply are proposed in this work. The corresponding computations were made to confirm the assumptions. The calculations were carried out in context of uncertainty of input data using a set of methods for the analysis of hierarchies, exhaustive search, as well as the methods of decision making in context of uncertainty.

  15. [Can Topical Negative Pressure Therapy be Performed as a Cost-Effective General Surgery Procedure in the German DRG System?].

    Science.gov (United States)

    Hirche, Z; Xiong, L; Hirche, C; Willis, S

    2016-04-01

    Topical negative pressure therapy (TNPT) has been established for surgical wound therapy with different indications. Nevertheless, there is only sparse evidence regarding its therapeutic superiority or cost-effectiveness in the German DRG system (G-DRG). This study was designed to analyse the cost-effectiveness of TNPT in the G-DRG system with a focus on daily treatment costs and reimbursement in a general surgery care setting. In this retrospective study, we included 176 patients, who underwent TNPT between 2007 and 2011 for general surgery indications. Analysis of the cost-effectiveness involved 149 patients who underwent a simulation to calculate the reimbursement with or without TNPT by a virtual control group in which the TNP procedure was withdrawn for DRG calculation. This was followed by a calculation of costs for wound dressings and TNPT rent and material costs. Comparison between the "true" and the virtual group enabled calculation of the effective remaining surplus per case. Total reimbursement by included TNPT cases was 2,323 ,70.04 €. Costs for wound dressings and TNPT rent were 102,669.20 €. In 41 cases there was a cost-effectiveness (27.5%) with 607,422.03 € with TNP treatment, while the control group without TNP generated revenues of 442,015.10 €. Costs for wound dressings and TNPT rent were 47,376.68 €. In the final account we could generate a cost-effectiveness of 6759 € in 5 years per 149 patients by TNPT. In 108 cases there was no cost-effectiveness (72.5%). TNPT applied in a representative general surgery setting allows for wound therapy without a major financial burden. Based on the costs for wound dressings and TNPT rent, a primarily medically based decision when to use TNPT can be performed in a balanced product cost accounting. This study does not analyse the superiority of TNPT in wound care, so further prospective studies are required which focus on therapeutic superiority and cost-effectiveness. Georg Thieme

  16. General Equilibrium in a Segmented Market Economy with Convex Transaction Cost: Existence, Efficiency, Commodity and Fiat Money

    OpenAIRE

    Starr, Ross M.

    2002-01-01

    This study derives the monetary structure of transactions, the use of commodity or fiat money, endogenously from transaction costs in a segmented market general equilibrium model. Market segmentation means there are separate budget constraints for each transaction: budgets balance in each transaction separately. Transaction costs imply differing bid and ask (selling and buying) prices. The most liquid instruments are those with the lowest proportionate bid/ask spread in equilibrium. Exist...

  17. An Analysis of the Romanian General Accounting Plan. Opportunities for Adaptation to the Activity-Based Costing (ABC Method

    Directory of Open Access Journals (Sweden)

    Irina-Alina Preda

    2008-11-01

    Full Text Available In this article, we analyze the causes that have led to the improvement of the Romanian general accounting plan according to the Activity- Based Costing (ABC method. We explain the advantages presented by the dissociated organization of management accounting, in contrast with the tabular- statistical form. The article also describes the methodological steps to be taken in the process of recording book entries, according to the Activity-Based Costing (ABC method in Romania.

  18. China’s regional industrial energy efficiency and carbon emissions abatement costs

    International Nuclear Information System (INIS)

    Wang, Ke; Wei, Yi-Ming

    2014-01-01

    Graphical abstract: Major cities in eight economy-geography regions of China. - Highlights: • Industrial energy and emissions efficiency were evaluated for China’s major cities. • Shadow prices of CO 2 emissions were estimated for China’s major cities. • Efficiency increase potentials on energy utilization and CO 2 emissions are 19% and 17%. • N-shaped EKC exists between levels of CO 2 emissions efficiency and income. • Average industrial CO 2 emissions abatement cost for China’s major cities is 45 US$. - Abstract: Evaluating the energy and emissions efficiency, measuring the energy saving and emissions reduction potential, and estimating the carbon price in China at the regional level are considered a crucial way to identify the regional efficiency levels and efficiency promotion potentials, as well as to explore the marginal abatement costs of carbon emissions in China. This study applies a newly developed Data Envelopment Analysis (DEA) based method to evaluate the regional energy and emissions efficiencies and the energy saving and emissions reduction potentials of the industrial sector of 30 Chinese major cities during 2006–2010. In addition, the CO 2 shadow prices, i.e., the marginal abatement costs of CO 2 emissions from industrial sector of these cities are estimated during the same period. The main findings are: (i) The coast area cities have the highest total factor industrial energy and emissions efficiency, but efficiency of the west area cities are lowest, and there is statistically significant efficiency difference between these cities. (ii) Economically well-developed cities evidence higher efficiency, and there is still obviously unbalanced and inequitable growth in the nationwide industrial development of China. (iii) Fortunately, the energy utilization and CO 2 emissions efficiency gaps among different Chinese cities were decreasing since 2006, and the problem of inequitable nationwide development has started to mitigate. (iv

  19. Comparative Cost Study by Southeastern Regional Association of Physical Plant Administrators of Universities and Colleges Standards Committee.

    Science.gov (United States)

    Duke Univ., Durham, NC.

    Presented in this document are data pertaining to maintenance and operations costs at colleges and universities in the southeastern region of the U.S. The major accounts included in the cost analysis are: (1) physical plant administration, (2) building maintenance, (3) custodial services, (4) utilities, (5) landscape and grounds maintenance, and…

  20. A decision analytical cost analysis of offering ECV in a UK district general hospital

    Directory of Open Access Journals (Sweden)

    Burr Robin

    2001-07-01

    Full Text Available Abstract Objective To determine the care pathways and implications of offering mothers the choice of external cephalic version (ECV at term for singleton babies who present with an uncomplicated breech pregnancy versus assisted breech delivery or elective caesarean. Design A prospective observational audit to construct a decision analysis of uncomplicated full term breech presentations. Setting The North Staffordshire NHS Trust. Subjects All women (n = 176 who presented at full term with a breech baby without complications during July 1995 and June 1997. Main outcome measures The study determined to compare the outcome in terms of the costs and cost consequences for the care pathways that resulted from whether a women chose to accept the offer of ECV or not. All the associated events were then mapped for the two possible pathways. The costs were considered only within the hospital setting, from the perspective of the health care provider up to the point of delivery. Results The additional costs for ECV, assisted breech delivery and elective caesarean over and above a normal birth were £186.70, £425.36 and £1,955.22 respectively. The total expected cost of the respective care pathways for "ECV accepted" and "ECV not accepted" (including the probability of adverse events were £1,452 and £1,828 respectively, that is the cost of delivery through the ECV care pathways is less costly than the non ECV delivery care pathway. Conclusions Implementing an ECV service may yield cost savings in secondary care over and above the traditional delivery methods for breech birth of assisted delivery or caesarean section. The scale of these expected cost savings are in the range of £248 to £376 per patient. This converts to a total expected cost saving of between £43,616 and £44,544 for the patient cohort considered in this study.

  1. CT-guided percutaneous radiofrequency ablation of hepatic malignancies located in unusual regions under general anesthesia

    International Nuclear Information System (INIS)

    Pan Jie; Chen Shaohui; Lu Xin; Mao Yilei; Sang Xinting; Chen Fang; Li Yumei; Huang Yuguang; Jin Zhengyu

    2010-01-01

    Objective: To discuss the feasibility of CT-guided percutaneous radiofrequency ablation (RFA) of liver malignancies located in unusual regions under general anesthesia, and to assess its clinical value. Methods: Eighteen patients with a total of 26 malignant hepatic lesions were enrolled in this study. The lesions were located at diaphragmatic surface, hepatic hilum, hepatic subcapsular site,side of inferior vena cava, side of gallbladder or near by colon. Transcatheter arterial chemoembolization was performed in all patients, which was followed by CT-guided percutaneous RFA under general anesthesia. The time used for puncturing and the time used for putting the needles to the scheduled sites were recorded. A follow-up for 115 months was conducted. The complications and the therapeutic results were observed. Results: For all patients,the procedure of puncture and needle placement was completed in 1-3 minutes. A total of 35 RFA procedures were conducted for 26 lesions. No severe complications occurred. Complete necrosis was observed in 20 tumors and partial necrosis in 6 tumors. Conclusion: The result of this study indicates that CT-guided percutaneous RFA under general anesthesia is a feasible technique for the treatment of liver malignancies located at unusual regions. This technique is very helpful for reducing the manipulating difficulty and lowing the complication risk of RFA procedures. (authors)

  2. Networks and RegionalCompetitiveness: Towards a Transaction Cost Approach of Small-Scale Cooperation

    Directory of Open Access Journals (Sweden)

    Daniel Friel

    2005-06-01

    Full Text Available A preoccupation with competition often dominates the study of governance. A focus on competition often unnecessarily precludes the possibility that regional institutions can suspend competition in certain areas and facilitate cooperation among potential rivals, thereby potentially contributing to their mutual success. In many ways companies cooperating through these types of networks have a greater degree of flexibility than firms which are forced to rely solely on hierarchies or markets for solutions to their problems. In order to fully understand how such networks work, this article first parses out differences in definitions of networks in order to understand how the type of network mentioned above actually differs from other uses of this term. Then it develops a theory of governance that goes beyond hierarchies and markets by demonstrating how this type of network can lead to reductions in transaction costs. This claim is illustrated on hand from examples of alternative forms of organization in Germany and Italy.

  3. Fracture liaison service in a non-regional orthopaedic clinic--a cost-effective service.

    LENUS (Irish Health Repository)

    Ahmed, M

    2012-01-01

    Fracture liaison services (FLS) aim to provide cost-effective targeting of secondary fracture prevention. It is proposed that a dedicated FLS be available in any hospital to which a patient presents with a fracture. An existing orthopaedic clinic nurse was retrained to deliver a FLS. Proformas were used so that different nurses could assume the fracture liaison nurse (FLN) role, as required. Screening consisted of fracture risk estimation, phlebotomy and DXA scanning. 124 (11%) of all patients attending the orthopaedic fracture clinic were reviewed in the FLS. Upper limb fractures accounted for the majority of fragility fractures screened n=69 (55.6%). Two-thirds of patients (n=69) had reduced bone mineral density (BMD). An evidence based approach to both non-pharmacological and pharmacotherapy was used and most patients (76.6%) receiving pharmacotherapy received an oral bisphosphonate (n=46). The FLS has proven to be an effective way of delivering secondary prevention for osteoporotic fracture in a non-regional fracture clinic, without increasing staff costs.

  4. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial

    NARCIS (Netherlands)

    Korthals-de Bos, Ingeborg B. C.; Hoving, Jan L.; van Tulder, Maurits W.; Rutten-van Mölken, Maureen P. M. H.; Adèr, Herman J.; de Vet, Henrica C. W.; Koes, Bart W.; Vondeling, Hindrik; Bouter, Lex M.

    2003-01-01

    OBJECTIVE: To evaluate the cost effectiveness of physiotherapy, manual therapy, and care by a general practitioner for patients with neck pain. DESIGN: Economic evaluation alongside a randomised controlled trial. SETTING: Primary care. PARTICIPANTS: 183 patients with neck pain for at least two weeks

  5. Robust Guaranteed Cost Observer Design for Singular Markovian Jump Time-Delay Systems with Generally Incomplete Transition Probability

    Directory of Open Access Journals (Sweden)

    Yanbo Li

    2014-01-01

    Full Text Available This paper is devoted to the investigation of the design of robust guaranteed cost observer for a class of linear singular Markovian jump time-delay systems with generally incomplete transition probability. In this singular model, each transition rate can be completely unknown or only its estimate value is known. Based on stability theory of stochastic differential equations and linear matrix inequality (LMI technique, we design an observer to ensure that, for all uncertainties, the resulting augmented system is regular, impulse free, and robust stochastically stable with the proposed guaranteed cost performance. Finally, a convex optimization problem with LMI constraints is formulated to design the suboptimal guaranteed cost filters for linear singular Markovian jump time-delay systems with generally incomplete transition probability.

  6. Economic Cost Analysis Related to Complications in General and Digestive Surgery.

    Science.gov (United States)

    Gomez-Rosado, Juan-Carlos; Salas-Turrens, Jose; Olry-de-Labry-Lima, Antonio

    2018-04-21

    The aim was to assess the impact on economic costs and length of stay (LOS) of postoperative complications. 5,822 records from BMDS (2014-2015) are included. A descriptive, univariate and multivariate study evaluated the correlation between complications, Clavien-Dindo grade and vacation periods with LOS and economic costs, based on a full-cost model, aggregated by DRG. Mean cost per stay was €676.71, and €4,309.02 per episode. Complications appeared in 639 patients (11%). Admission to ICU was required in 203 patients, re-operation in 134 and re-admission in 243, while 66 patients died (1.1%). Complications caused significantly longer LOS (20.08 vs 5.48 days) and higher economic cost (€11,670.31 vs €3,354.12); infectious complications were the most frequent and respiratory the most expensive (€20,428.53), together with ICU admission (€20,242.66). Clavien-Dindo grade correlated with greater LOS and costs (except gradev). During vacation periods, complications and LOS are increased, but costs of these complications and LOS did not differ significantly from complications detected in non-vacation periods. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Cost analysis of a school-based comprehensive malaria program in primary schools in Sikasso region, Mali.

    Science.gov (United States)

    Maccario, Roberta; Rouhani, Saba; Drake, Tom; Nagy, Annie; Bamadio, Modibo; Diarra, Seybou; Djanken, Souleymane; Roschnik, Natalie; Clarke, Siân E; Sacko, Moussa; Brooker, Simon; Thuilliez, Josselin

    2017-06-12

    The expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets (LLIN), and Intermittent Parasite Clearance in schools (IPCs) in southern Mali. Costs were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools (6413 children). A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed. The economic cost of the comprehensive intervention was estimated to $10.38 per child (financial cost $8.41) with malaria education, LLIN distribution and IPCs costing $2.13 (20.5%), $5.53 (53.3%) and $2.72 (26.2%) per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child. A comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.

  8. Cost analysis of a school-based comprehensive malaria program in primary schools in Sikasso region, Mali

    Directory of Open Access Journals (Sweden)

    Roberta Maccario

    2017-06-01

    Full Text Available Abstract Background The expansion of malaria prevention and control to school-aged children is receiving increasing attention, but there are still limited data on the costs of intervention. This paper analyses the costs of a comprehensive school-based intervention strategy, delivered by teachers, that included participatory malaria educational activities, distribution of long lasting insecticide-treated nets (LLIN, and Intermittent Parasite Clearance in schools (IPCs in southern Mali. Methods Costs were collected alongside a randomised controlled trial conducted in 80 primary schools in Sikasso Region in Mali in 2010-2012. Cost data were compiled between November 2011 and March 2012 for the 40 intervention schools (6413 children. A provider perspective was adopted. Using an ingredients approach, costs were classified by cost category and by activity. Total costs and cost per child were estimated for the actual intervention, as well as for a simpler version of the programme more suited for scale-up by the government. Univariate sensitivity analysis was performed. Results The economic cost of the comprehensive intervention was estimated to $10.38 per child (financial cost $8.41 with malaria education, LLIN distribution and IPCs costing $2.13 (20.5%, $5.53 (53.3% and $2.72 (26.2% per child respectively. Human resources were found to be the key cost driver, and training costs were the greatest contributor to overall programme costs. Sensitivity analysis showed that an adapted intervention delivering one LLIN instead of two would lower the economic cost to $8.66 per child; and that excluding LLIN distribution in schools altogether, for example in settings where malaria control already includes universal distribution of LLINs at community-level, would reduce costs to $4.89 per child. Conclusions A comprehensive school-based control strategy may be a feasible and affordable way to address the burden of malaria among schoolchildren in the Sahel.

  9. Application of a generalized Leibniz rule for calculating electromagnetic fields within continuous source regions

    International Nuclear Information System (INIS)

    Silberstein, M.

    1991-01-01

    In deriving the electric and magnetic fields in a continuous source region by differentiating the vector potential, Yaghjian (1985) explains that the central obstacle is the dependence of the integration limits on the differentiation variable. Since it is not mathematically rigorous to assume the curl and integral signs are interchangeable, he uses an integration variable substitution to circumvent this problematic dependence. Here, an alternative derivation is presented, which evaluates the curl of the vector potential volume integral directly, retaining the dependence of the limits of integration on the differentiation variable. It involves deriving a three-dimensional version of Leibniz' rule for differentiating an integral with variable limits of integration, and using the generalized rule to find the Maxwellian and cavity fields in the source region. 7 refs

  10. Regional economic activity and absenteeism: a new approach to estimating the indirect costs of employee productivity loss.

    Science.gov (United States)

    Bankert, Brian; Coberley, Carter; Pope, James E; Wells, Aaron

    2015-02-01

    This paper presents a new approach to estimating the indirect costs of health-related absenteeism. Productivity losses related to employee absenteeism have negative business implications for employers and these losses effectively deprive the business of an expected level of employee labor. The approach herein quantifies absenteeism cost using an output per labor hour-based method and extends employer-level results to the region. This new approach was applied to the employed population of 3 health insurance carriers. The economic cost of absenteeism was estimated to be $6.8 million, $0.8 million, and $0.7 million on average for the 3 employers; regional losses were roughly twice the magnitude of employer-specific losses. The new approach suggests that costs related to absenteeism for high output per labor hour industries exceed similar estimates derived from application of the human capital approach. The materially higher costs under the new approach emphasize the importance of accurately estimating productivity losses.

  11. Wastewater Reuse for Agriculture: Development of a Regional Water Reuse Decision-Support Model (RWRM) for Cost-Effective Irrigation Sources.

    Science.gov (United States)

    Tran, Quynh K; Schwabe, Kurt A; Jassby, David

    2016-09-06

    Water scarcity has become a critical problem in many semiarid and arid regions. The single largest water use in such regions is for crop irrigation, which typically relies on groundwater and surface water sources. With increasing stress on these traditional water sources, it is important to consider alternative irrigation sources for areas with limited freshwater resources. One potential irrigation water resource is treated wastewater for agricultural fields located near urban centers. In addition, treated wastewater can contribute an appreciable amount of necessary nutrients for plants. The suitability of reclaimed water for specific applications depends on water quality and usage requirements. The main factors that determine the suitability of recycled water for agricultural irrigation are salinity, heavy metals, and pathogens, which cause adverse effects on human, plants, and soils. In this paper, we develop a regional water reuse decision-support model (RWRM) using the general algebraic modeling system to analyze the cost-effectiveness of alternative treatment trains to generate irrigation water from reclaimed wastewater, with the irrigation water designed to meet crop requirements as well as California's wastewater reuse regulations (Title 22). Using a cost-minimization framework, least-cost solutions consisting of treatment processes and their intensities (blending ratios) are identified to produce alternative irrigation sources for citrus and turfgrass. Our analysis illustrates the benefits of employing an optimization framework and flexible treatment design to identify cost-effective blending opportunities that may produce high-quality irrigation water for a wide range of end uses.

  12. OPERATIONAL COSTS OF CANAL COMPANIES AND IRRIGATION DISTRICTS IN THE INTERMOUNTAIN REGION

    OpenAIRE

    Wilkins-Wells, John; Lagae, Hubert J.; Anderson, Raymond L.; Anwer, Muhammad Sarfraz

    1999-01-01

    This study reports on the trends of operational costs of farmer owned and operated irrigation enterprises (irrigation districts and canal companies) in five intermountain states. Administrative costs have risen faster then operation and maintenance costs. While salaries of employees have not risen significantly over time, legal costs have greatly escalated.

  13. Geographical Pattern and Environmental Correlates of Regional-Scale General Flowering in Peninsular Malaysia

    Science.gov (United States)

    Numata, Shinya; Yasuda, Masatoshi; Suzuki, Ryo O.; Hosaka, Tetsuro; Noor, Nur Supardi Md.; Fletcher, Christine D.; Hashim, Mazlan

    2013-01-01

    In South-East Asian dipterocarp forests, many trees synchronize their reproduction at the community level, but irregularly, in a phenomenon known as general flowering (GF). Several proximate cues have been proposed as triggers for the synchronization of Southeast Asian GF, but the debate continues, as many studies have not considered geographical variation in climate and flora. We hypothesized that the spatial pattern of GF forests is explained by previously proposed climatic cues if there are common cues for GF among regions. During the study, GF episodes occurred every year, but the spatial occurrence varied considerably from just a few forests to the whole of Peninsular Malaysia. In 2001, 2002 and 2005, minor and major GF occurred widely throughout Peninsular Malaysia (GF2001, GF2002, and GF2005), and the geographical patterns of GF varied between the episodes. In the three regional-scale GF episodes, most major events occurred in regions where prolonged drought (PD) had been recorded prior, and significant associations between GF scores and PD were found in GF2001 and GF2002. However, the frequency of PD was higher than that of GF throughout the peninsula. In contrast, low temperature (LT) was observed during the study period only before GF2002 and GF2005, but there was no clear spatial relationship between GF and LT in the regional-scale episodes. There was also no evidence that last GF condition influenced the magnitude of GF. Thus, our results suggest that PD would be essential to trigger regional-scale GF in the peninsula, but also that PD does not fully explain the spatial and temporal patterns of GF. The coarse relationships between GF and the proposed climatic cues may be due to the geographical variation in proximate cues for GF, and the climatic and floristic geographical variations should be considered to understand the proximate factors of GF. PMID:24260159

  14. Stratospheric Ozone Distribution and Tropospheric General Circulation: Interconnections in the UTLS Region

    Science.gov (United States)

    Barodka, S.; Krasovsky, A.; Shalamyansky, A.

    2014-12-01

    The height of the tropopause, which divided the stratosphere and the troposphere, is a result of two rival categories of processes: the tropospheric vertical convection and the radiative heating of the stratosphere resulting from the ozone cycle. Hence, it is natural that tropospheric and stratospheric phenomena can have effect each other in manifold processes of stratosphere-troposphere interactions. In the present study we focus our attention to the "top-down" side of the interaction: the impact of stratospheric ozone distribution on the features of tropospheric circulation and the associated weather patterns and regional climate conditions. We proceed from analyzes of the observational data performed at the A.I. Voeikov Main Geophysical Observatory, which suggest a distinct correlation between stratospheric ozone distribution, synoptic formations and air-masses boundaries in the upper troposphere and the temperature field of the lower stratosphere [1]. Furthermore, we analyze local features of atmospheric general circulation and stratospheric ozone distribution from the atmospheric reanalyses and general circulation model data, focusing our attention to instantaneous positions of subtropical and polar stationary atmospheric fronts, which define regional characteristics of the general circulation cells in the troposphere and separate global tropospheric air-masses, correspond to distinct meteorological regimes in the TOC field [2, 3]. We assume that by altering the tropopause height, stratospheric ozone-related processes can have an impact on the location of the stationary atmospheric fronts, thereby exerting influence on circulation processes in troposphere and lower stratosphere. For midlatitudes, the tropopause height controls the position of the polar stationary front, which has a direct impact on the trajectory of motion of active vortices on synoptic tropospheric levels, thereby controlling weather patterns in that region and the regional climate. This

  15. Cost justification of clinical pharmacy services on a general surgery team: focus on diagnosis-related group cases.

    Science.gov (United States)

    Bertch, K E; Hatoum, H T; Willett, M S; Witte, K W

    1988-11-01

    We used a novel approach to cost-justify clinical pharmacy services on a general surgery team in nine diagnosis-related group cases. The clinical pharmacist monitored nine patients longitudinally on a general surgery team from admission to discharge and intervened in their therapeutic management. Each recommendation was analyzed for rationale, acceptance, perceived impact on quality and/or cost of patient care, whether self-initiated or solicited, and impact on patient outcome. Types of recommendations and outcomes were categorized by process and outcome measurement criteria. Total cost avoidance per patient was calculated using costs of drug therapy, laboratory tests, and length of stay. Accounting for cost of clinical pharmacy services, net cost avoidance per patient was calculated. The clinical pharmacist made 101 recommendations on nine patients. Physicians accepted 82 percent of the recommendations; 77 percent of the recommendations were self-initiated and 23 percent were solicited. Recommendations had a perceived impact on cost, quality, or both at 13, 31, and 56 percent, respectively. Most recommendations (79 percent) brought patient therapy to a level of conformance with current standards of practice as documented in the medical literature. Recommendations that potentially preserved a major organ function by preventing drug-induced toxicity or the exacerbation of existing problems constituted 16 percent of the total. None of the accepted recommendations adversely affected patient outcome and 23 percent directly resulted in a measurable positive outcome in patient care. A total of four hospital days was potentially saved for two cases. Based on objective outcome criteria, a 1.9-day increase in therapeutic control was documented per patient.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Generalized query-based active learning to identify differentially methylated regions in DNA.

    Science.gov (United States)

    Haque, Md Muksitul; Holder, Lawrence B; Skinner, Michael K; Cook, Diane J

    2013-01-01

    Active learning is a supervised learning technique that reduces the number of examples required for building a successful classifier, because it can choose the data it learns from. This technique holds promise for many biological domains in which classified examples are expensive and time-consuming to obtain. Most traditional active learning methods ask very specific queries to the Oracle (e.g., a human expert) to label an unlabeled example. The example may consist of numerous features, many of which are irrelevant. Removing such features will create a shorter query with only relevant features, and it will be easier for the Oracle to answer. We propose a generalized query-based active learning (GQAL) approach that constructs generalized queries based on multiple instances. By constructing appropriately generalized queries, we can achieve higher accuracy compared to traditional active learning methods. We apply our active learning method to find differentially DNA methylated regions (DMRs). DMRs are DNA locations in the genome that are known to be involved in tissue differentiation, epigenetic regulation, and disease. We also apply our method on 13 other data sets and show that our method is better than another popular active learning technique.

  17. Evaluation of proposed casemix criteria as a basis for costing patients in the adult general intensive care unit.

    Science.gov (United States)

    Stevens, V G; Hibbert, C L; Edbrooke, D L

    1998-10-01

    This study analyses the relationship between the actual patient-related costs of care calculated for 145 patients admitted sequentially to an adult general intensive care unit and a number of factors obtained from a previously described consensus of opinion study. The factors identified in the study were suggested as potential descriptors for the casemix in an intensive care unit that could be used to predict the costs of care. Significant correlations between the costs of care and severity of illness, workload and length of stay were found but these failed to predict the costs of care with sufficient accuracy to be used in isolation to define isoresource groups in the intensive care unit. No associations between intensive care unit mortality, reason for admission and intensive and unit treatments and costs of care were found. Based on these results, it seems that casemix descriptors and isoresource groups for the intensive care unit that would allow costs to be predicted cannot be defined in terms of single factors.

  18. 29 CFR 531.3 - General determinations of “reasonable cost.”

    Science.gov (United States)

    2010-07-01

    ... employer: Provided, That if the total so computed is more than the fair rental value (or the fair price of the commodities or facilities offered for sale), the fair rental value (or the fair price of the... REGULATIONS WAGE PAYMENTS UNDER THE FAIR LABOR STANDARDS ACT OF 1938 Determinations of âReasonable Costâ and â...

  19. Distance-Based Image Classification: Generalizing to New Classes at Near Zero Cost

    NARCIS (Netherlands)

    Mensink, T.; Verbeek, J.; Perronnin, F.; Csurka, G.

    2013-01-01

    We study large-scale image classification methods that can incorporate new classes and training images continuously over time at negligible cost. To this end, we consider two distance-based classifiers, the k-nearest neighbor (k-NN) and nearest class mean (NCM) classifiers, and introduce a new

  20. Cost of hospital care for HIV/AIDS infected patients in three general ...

    African Journals Online (AJOL)

    Monthly income and the level of education were both statistically significant predictors for healthcare consumption. The analysis allows us to extend the study by using different analytical accounting approaches such as by case and by pathology. Key words: Healthcare costs, HIV AIDS, Predictive factors for healthcare ...

  1. Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free

    NARCIS (Netherlands)

    Zijlstra, T.R.; Braakman-Jansen, Louise Marie Antoinette; Taal, Erik; Rasker, Johannes J.; van de Laar, Mart A F J

    2007-01-01

    Objectives: To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome (FM). - Methods: 134 patients with FM, selected from a rheumatology outpatient department and from members of the Dutch FM patient

  2. THE COST OF CREDIBILITY: THE COMPANY OF GENERAL FARMS AND FISCAL STAGNATION IN EIGHTEENTH-CENTURY FRANCE

    Directory of Open Access Journals (Sweden)

    Noel D. Johnson

    2006-01-01

    Full Text Available The Company of General Farms, a quasi-private collector of about half the French taxes in the eighteenth century, was one of the largest lenders to the Crown. The relationship between the Crown and General Farms fits the model of sovereign debt as a contingent claim. Lending is sustained in contingent claims models if the lender credibly commits to withhold funds from the sovereign if he defaults. The General Farms maintained this commitment with amonopsony of the Crown's access to taxes and borrowed funds. When revolution threatened, the monopsony stood between the Crown and reform of the fiscal system. The history of the Company of General Farms shows how a contingent claims equilibrium can raise the cost of legitimate reform.

  3. Coste del cuidado informal del ictus en una población general no institucionalizada Cost of informal care for stroke victims in a non-institutionalized general population

    Directory of Open Access Journals (Sweden)

    Adolfo Hervás

    2007-12-01

    Full Text Available Antecedentes: El impacto social del ictus es importante por tratarse de una enfermedad invalidante, que causa dependencia y necesidad de cuidados informales. La importancia de la dependencia cada vez es mayor en la sociedad, pero no hay registros de los costes del cuidado informal, y se desconoce cómo valorarla. Objetivos: Calcular el coste del cuidado informal del ictus en una población general y analizarlo en función del grado de dependencia. Realizar un análisis de sensibilidad con la variable costes unitarios a partir de fuentes diversas. Material y métodos: Se estudian todos los casos diagnosticados de ictus a 31 de diciembre de 2004 (n = 95 pertenecientes a una zona básica de salud de Navarra, de los que 40 (44,4% precisan cuidados informales. Se valora la dependencia para las actividades de la vida diaria mediante los índices de Barthel (actividades básicas [ABVD] y Lawton-Brody (actividades instrumentales [AIVD]. La valoración del tiempo del cuidado informal se realiza con una aproximación de abajo a arriba (bottom-up, mediante un cuestionario de recogida de actividades diarias. Resultados: El coste del cuidado informal de los pacientes con ictus es de 21.551,28 €/año, con un rango, según el análisis de sensibilidad, entre 6.490,80 y 31.436,72 €/año. Hay diferencias estadísticamente significativas en el coste del cuidado informal según el grado de dependencia (ABVD: 24.865,2 €/año; AIVD: 10.442,9 €/año. Conclusiones: El coste del cuidado informal en la atención al ictus es elevado y crece con el nivel de dependencia.Background: Stroke has a strong social impact since it causes disability, leading to dependency and the need for informal care. Although awareness of the importance of dependency is increasing, registries of the cost of informal care are lacking and consequently the real value of this activity to society is still unknown. Objectives: To calculate the cost of informal care of stroke victims in a

  4. Quality of stroke care at an Irish Regional General Hospital and Stroke Rehabilitation Unit.

    LENUS (Irish Health Repository)

    Walsh, T

    2012-01-31

    BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.

  5. Regional (spinal, epidural, caudal) versus general anaesthesia in preterm infants undergoing inguinal herniorrhaphy in early infancy.

    Science.gov (United States)

    Jones, Lisa J; Craven, Paul D; Lakkundi, Anil; Foster, Jann P; Badawi, Nadia

    2015-06-09

    With improvements in neonatal intensive care, more preterm infants are surviving the neonatal period and presenting for surgery in early infancy. Inguinal hernia is the most common condition requiring early surgery, appearing in 38% of infants whose birth weight is between 751 grams and 1000 grams. Approximately 20% to 30% of otherwise healthy preterm infants having general anaesthesia for inguinal hernia surgery at a postmature age have at least one apnoeic episode within the postoperative period. Research studies have failed to adequately distinguish the effects of apnoeic episodes from other complications of extreme preterm gestation on the risk of brain injury, or to investigate the potential impact of postoperative apnoea upon longer term neurodevelopment. In addition to episodes of apnoea, there are concerns that anaesthetic and sedative agents may have a direct toxic effect on the developing brain of preterm infants even after reaching postmature age. It is proposed that regional anaesthesia may reduce the risk of postoperative apnoea, avoid the risk of anaesthetic-related neurotoxicity and improve neurodevelopmental outcomes in preterm infants requiring surgery for inguinal hernia at a postmature age. To determine if regional anaesthesia reduces postoperative apnoea, bradycardia, the use of assisted ventilation, and neurological impairment, in comparison to general anaesthesia, in preterm infants undergoing inguinal herniorrhaphy at a postmature age. The following databases and resources were searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2015, Issue 2), MEDLINE (December 2002 to 25 February 2015), EMBASE (December 2002 to 25 February 2015), controlled-trials.com and clinicaltrials.gov, reference lists of published trials and abstracts published in Pediatric Research and Pediatric Anesthesia. Randomised and quasi-randomised controlled trials of regional (spinal, epidural, caudal) versus general anaesthesia, or

  6. Metabolic Compensation of Fitness Costs Is a General Outcome for Antibiotic-Resistant Pseudomonas aeruginosa Mutants Overexpressing Efflux Pumps.

    Science.gov (United States)

    Olivares Pacheco, Jorge; Alvarez-Ortega, Carolina; Alcalde Rico, Manuel; Martínez, José Luis

    2017-07-25

    It is generally assumed that the acquisition of antibiotic resistance is associated with a fitness cost. We have shown that overexpression of the MexEF-OprN efflux pump does not decrease the fitness of a resistant Pseudomonas aeruginosa strain compared to its wild-type counterpart. This lack of fitness cost was associated with a metabolic rewiring that includes increased expression of the anaerobic nitrate respiratory chain when cells are growing under fully aerobic conditions. It was not clear whether this metabolic compensation was exclusive to strains overexpressing MexEF-OprN or if it extended to other resistant strains that overexpress similar systems. To answer this question, we studied a set of P. aeruginosa mutants that independently overexpress the MexAB-OprM, MexCD-OprJ, or MexXY efflux pumps. We observed increased expression of the anaerobic nitrate respiratory chain in all cases, with a concomitant increase in NO 3 consumption and NO production. These efflux pumps are proton/substrate antiporters, and their overexpression may lead to intracellular H + accumulation, which may in turn offset the pH homeostasis. Indeed, all studied mutants showed a decrease in intracellular pH under anaerobic conditions. The fastest way to eliminate the excess of protons is by increasing oxygen consumption, a feature also displayed by all analyzed mutants. Taken together, our results support metabolic rewiring as a general mechanism to avoid the fitness costs derived from overexpression of P. aeruginosa multidrug efflux pumps. The development of drugs that block this metabolic "reaccommodation" might help in reducing the persistence and spread of antibiotic resistance elements among bacterial populations. IMPORTANCE It is widely accepted that the acquisition of resistance confers a fitness cost in such a way that in the absence of antibiotics, resistant populations will be outcompeted by susceptible ones. Based on this assumption, antibiotic cycling regimes have been

  7. Galician mining and metallurgy in the light of the General Regional Exhibition of Lviv in 1894

    Directory of Open Access Journals (Sweden)

    Wojciech Paduchowski

    2014-12-01

    Full Text Available The General Regional Exhibition of Lviv was organized in 1894, on the 100 year anniversary of the Kosciuszko Uprising of 1794. The Exhibition was meant to demonstrate Galicia’s economical and cultural progress since its gaining political autonomy and to become an opportunity for the national integration of Poles. The Exhibition displays included various thematic groups which were devoted to both spiritual and material aspects of life in Galicia and were meant to show the abundance of its crops and produce, mining and metallurgy, agriculture, forestry and hunting. The shows pictured everyday life of the inhabitants of Galicia, its folk art, so-called domestic industry and craftwork. Other sections of the Exhibition demonstrated the development of the Galician financial institutions, public administration, healthcare, communication, engineering, construction, literature, general and vocational education and the bloom of the fine arts and architecture. The article analyzes only some parts of the great legacy of the Exhibition, its scope focuses on mining and metallurgy. The text points out the dynamic development of the oil industry and the increase in the branches such as: salt production, iron smelting, and brown and hard coal extraction. The only branch of the Galicia’s economy which had not offered good perspectives and was thus soon discontinued had been the production of earthwax (ozocerite. The organization of the exhibitions of such sort was regarded at that time as one of the best ways to stimulate economy and benefit the regions. The actual development itself, especially of the oil mining, aided many positive social and cultural changes and undoubtedly increased the societal potential and might have resulted in further initiatives.

  8. Increased risk environment for emergency general surgery in the context of regionalization and specialization.

    Science.gov (United States)

    Beecher, S; O'Leary, D P; McLaughlin, R

    2015-09-01

    The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  9. The cost of chronic pain: an analysis of a regional pain management service in Ireland.

    Science.gov (United States)

    Gannon, Brenda; Finn, David P; O'Gorman, David; Ruane, Nancy; McGuire, Brian E

    2013-10-01

    The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. Our study showed a cost per patient of US$24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden. Wiley Periodicals, Inc.

  10. Cost-effectiveness analysis of clinic-based chloral hydrate sedation versus general anaesthesia for paediatric ophthalmological procedures.

    Science.gov (United States)

    Burnett, Heather F; Lambley, Rosemary; West, Stephanie K; Ungar, Wendy J; Mireskandari, Kamiar

    2015-11-01

    The inability of some children to tolerate detailed eye examinations often necessitates general anaesthesia (GA). The objective was to assess the incremental cost effectiveness of paediatric eye examinations carried out in an outpatient sedation unit compared with GA. An episode of care cost-effectiveness analysis was conducted from a societal perspective. Model inputs were based on a retrospective cross-over cohort of Canadian children aged Costs ($CAN), adverse events and number of successful procedures were modelled in a decision analysis with one-way and probabilistic sensitivity analysis. The mean cost per patient was $406 (95% CI $401 to $411) for EUS and $1135 (95% CI $1125 to $1145) for EUA. The mean number of successful procedures per patient was 1.39 (95% CI 1.34 to 1.42) for EUS and 2.06 (95% CI 2.02 to 2.11) for EUA. EUA was $729 more costly on average than EUS (95% CI $719 to $738) but resulted in an additional 0.68 successful procedures per child. The result was robust to varying the cost assumptions. Cross-over designs offer a powerful way to assess costs and effectiveness of two interventions because patients serve as their own control. This study demonstrated significant savings when ophthalmological exams were carried out in a hospital outpatient clinic, although with slightly fewer procedures completed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. 34 CFR 76.565 - General management costs-restricted rate.

    Science.gov (United States)

    2010-07-01

    ... that are for the direction and control of the grantee's affairs that are organization-wide. An activity...) Components of the grantee are those organizational units supervised directly or indirectly by the chief executive officer. These organizational units generally exist one management level below the executive...

  12. Regional disparity and cost-effective SO2 pollution control in China: A case study in 5 mega-cities

    International Nuclear Information System (INIS)

    Kanada, Momoe; Dong, Liang; Fujita, Tsuyoshi; Fujii, Minoru; Inoue, Tsuyoshi; Hirano, Yujiro; Togawa, Takuya; Geng, Yong

    2013-01-01

    With rapid development, increasing sulfur dioxide (SO 2 ) emission becomes a key environmental issue in China. To respond to this challenge, the Chinese government established a top-down scheme to reduce its SO 2 emissions. However, regional disparity and the associated cost differences brought uncertainties to the policy effectiveness and efficiency. Few studies focus on this field. Therefore, this study tries to fill such a gap by investigating the differences of SO 2 emissions, reduction potential, and cost-effectiveness through use of the GAINS-China model in five mega-cities in China, namely, Beijing, Shanghai, Tianjin, Chongqing, and Hong Kong. A scenario analysis approach is employed, focusing on two technologies named flue gas desulfurization (FGD) and limestone injection (LINJ). Results demonstrated that a large SO 2 reduction potential exists, as well as a great disparity, among the five mega-cities. Chongqing had the largest reduction potential with lowest unit cost, while Beijng and Hong Kong showed the lowest reduction potential with higher unit cost. In Beijing and Shanghai, FGD and LINJ in the power generation sector had the larger reduction potential with the highest cost-effectiveness. However, in Chongqing, the industry sectors also had large reduction potentials. Finally, appropriate SO 2 control strategies and policies are raised by considering the local realities. - Highlights: • The cost-effectiveness of SO 2 control policy was analyzed in five mega-cities in China. • Reduction potential and cost-effectiveness were closely linked to regional disparity. • Beijing and Hong Kong showed lower reduction potential and higher marginal reduction cost. • Chongqing showed the largest reduction potential and the lowest marginal reduction cost

  13. Generalized economic model for evaluating disposal costs at a low-level waste disposal facility

    International Nuclear Information System (INIS)

    Baird, R.D.; Rogers, V.C.

    1985-01-01

    An economic model is developed which can be used to evaluate cash flows associated with the development, operations, closure, and long-term maintenance of a proposed Low-Level Radioactive Waste disposal facility and to determine the unit disposal charges and unit surcharges which might result. The model includes the effects of nominal interest rate (rate of return on investment, or cost of capital), inflation rate, waste volume growth rate, site capacity, duration of various phases of the facility history, and the cash flows associated with each phase. The model uses standard discounted cash flow techniques on an after-tax basis to determine that unit disposal charge which is necessary to cover all costs and expenses and to generate an adequate rate of return on investment. It separately considers cash flows associated with post-operational activities to determine the required unit surcharge. The model is applied to three reference facilities to determine the respective unit disposal charges and unit surcharges, with various values of parameters. The sensitivity of the model results are evaluated for the unit disposal charge

  14. Taxes, cost and demand shifters as determinants in the regional gasoline price formation process: Evidence from Spain

    International Nuclear Information System (INIS)

    Bello, Alejandro; Contín-Pilart, Ignacio

    2012-01-01

    This paper examines the pass-through of regional tax changes and spot price variations to regional gasoline prices in Spain. It also analyzes the impact of all major cost and demand shifters that contribute to regional gasoline price formation. To address these research issues, a reduced form price equation using monthly time-series cross-sectional (TSCS) data from January 2004 through December 2008 is estimated. Strong and consistent evidence of full shifting of regional tax changes to regional gasoline prices is found. Gasoline spot price changes are more than proportionally passed through to retail prices. In addition, the empirical evidence shows, on the one hand, that regional gasoline price differences before taxes continue to be quite narrow and, on the other hand, that there is still a margin for larger gasoline price differences among regions. This suggest that “traditional practices” from the monopoly era (i.e. relatively uniform regional gasoline prices) persist after the market has been liberalized, which may have been facilitated by the strong and uniform presence of the major Spanish-based refining companies in the retail sector over the whole country. - Highlights: ► The paper analyzes the impact of all major demand and cost shifters that contribute to regional gasoline price formation. ► It shows that the relatively uniform regional gasoline prices persist after the Spanish gasoline market has been liberalized. ► It shows that regional tax changes are fully passed on to regional gasoline prices. ► It also shows that gasoline spot price changes are fully passed on to consumer prices.

  15. General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis.

    Science.gov (United States)

    Tsiachristas, Apostolos; McDaid, David; Casey, Deborah; Brand, Fiona; Leal, Jose; Park, A-La; Geulayov, Galit; Hawton, Keith

    2017-10-01

    costs of psychosocial assessments were £228 for adults and £392 for individuals younger than 18 years. If our findings are extrapolated to England, the estimated overall annual cost of general hospital management of self-harm is £162 million per year. More use of psychosocial assessment and other preventive measures, especially for young people and against self-poisoning, could potentially lower future costs at a time of major cost pressures in the NHS. National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research, Care Oxford at Oxford Health NHS Foundation Trust, and Department of Health. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

  16. 39 CFR 230.25 - Who pays the costs incurred when the Office of Inspector General responds to a demand for...

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Who pays the costs incurred when the Office of....25 Who pays the costs incurred when the Office of Inspector General responds to a demand for documents or testimony? (a) Unless determined by 28 U.S.C. 1821 or other applicable statute, the costs of...

  17. Matching comprehensive health insurance reimbursements to their real costs: the case of antenatal care visits in a region of Peru.

    Science.gov (United States)

    Cobos Muñoz, Daniel; Hansen, Kristian Schultz; Terris-Prestholt, Fern; Cianci, Fiona; Pérez-Lu, José Enrique; Lama, Aldo; García, Patricia J

    2015-01-01

    Prepaid contributory systems are increasingly being recognized as key mechanisms in achieving universal health coverage in low and middle-income countries. Peru created the Seguro Integral de Salud (SIS) to increase health service use amongst the poor by removing financial barriers. The SIS transfers funds on a fee-for-service basis to the regional health offices to cover recurrent cost (excluding salaries) of pre-specified packages of interventions. We aim to estimate the full cost of antenatal care (ANC) provision in the Ventanilla District (Callao-Peru) and to compare the actual cost to the reimbursement rates provided by SIS. The economic costs of ANC provision in 2011 in 8 of the 15 health centres in Ventanilla District were estimated from a provider perspective and the actual costs of those services covered by the SIS fee of $3.8 for each ANC visit were calculated. A combination of step-down and bottom-up costing methodologies was used. Sensitivity analysis was conducted to test the uncertainty around estimated parameters and model assumptions. Results are reported in 2011 US$. The total economic cost of ANC provision in all 8 health centres was $569,933 with an average cost per ANC visit of $31.3 (95 % CI $29.7-$33.5). Salaries comprised 74.4 % of the total cost. The average cost of the services covered by the SIS fee was $3.4 (95 % CI $3.0-$3.8) per ANC visit. Sensitivity analysis showed that the probability of the cost of an ANC visit being above the SIS reimbursed fee is 1.4 %. Our analysis suggests that the fee reimbursed by the SIS will cover the cost that it supposed to cover. However, there are significant threats to medium and longer term sustainability of this system as fee transfers represent a small fraction of the total cost of providing ANC. Increasing ANC coverage requires the other funding sources of the Regional Health Office (DIRESA) to adapt to increasing demand.

  18. Time and cost analysis: pediatric dental rehabilitation with general anesthesia in the office and the hospital settings.

    Science.gov (United States)

    Rashewsky, Stephanie; Parameswaran, Ashish; Sloane, Carole; Ferguson, Fred; Epstein, Ralph

    2012-01-01

    Pediatric dental patients who cannot receive dental care in the clinic due to uncooperative behavior are often referred to receive dental care under general anesthesia (GA). At Stony Brook Medicine, dental patients requiring treatment with GA receive dental care in our outpatient facility at the Stony Brook School of Dental Medicine (SDM) or in the Stony Brook University Hospital ambulatory setting (SBUH). This study investigates the time and cost for ambulatory American Society of Anesthesiologists (ASA) Class I pediatric patients receiving full-mouth dental rehabilitation using GA in these 2 locations, along with a descriptive analysis of the patients and dental services provided. In this institutional review board-approved cross-sectional retrospective study, ICD-9 codes for dental caries (521.00) were used to collect patient records between July 2009 and May 2011. Participants were limited to ASA I patients aged 36-60 months. Complete records from 96 patients were reviewed. There were significant differences in cost, total anesthesia time, and recovery room time (P average total time (anesthesia end time minus anesthesia start time) to treat a child at SBUH under GA was 222 ± 62.7 minutes, and recovery time (time of discharge minus anesthesia end time) was 157 ± 97.2 minutes; the average total cost was $7,303. At the SDM, the average total time was 175 ± 36.8 minutes, and recovery time was 25 ± 12.7 minutes; the average total cost was $414. After controlling for anesthesia time and procedures, we found that SBUH cost 13.2 times more than SDM. This study provides evidence that ASA I pediatric patients can receive full-mouth dental rehabilitation utilizing GA under the direction of dentist anesthesiologists in an office-based dental setting more quickly and at a lower cost. This is very promising for patients with the least access to care, including patients with special needs and lack of insurance.

  19. Health effects of the Chernobyl disaster: illness or illness behavior? A comparative general health survey in two former Soviet regions

    NARCIS (Netherlands)

    Havenaar, J.; Rumyantzeva, G.; Kasyanenko, A.; Kaasjager, K.; Westermann, Anneke; van den Brink, W.; van den Bout, J.; Savelkoul, J.

    1997-01-01

    Results are described of a general health survey (n = 3044) that was conducted 6.5 years after the Chernobyl accident in 1986 in a seriously contaminated region in Belarus and a socioeconomically comparable, but unaffected, region in the Russian Federation. The purpose of the study was to

  20. Economic efficiency and cost implications of habitat conservation: An example in the context of the Edwards Aquifer region

    Science.gov (United States)

    Gillig, Dhazn; McCarl, Bruce A.; Jones, Lonnie L.; Boadu, Frederick

    2004-04-01

    Groundwater management in the Edwards Aquifer in Texas is in the process of moving away from a traditional right of capture economic regime toward a more environmentally sensitive scheme designed to preserve endangered species habitats. This study explores economic and environmental implications of proposed groundwater management and water development strategies under a proposed regional Habitat Conservation Plan. Results show that enhancing the habitat by augmenting water flow costs $109-1427 per acre-foot and that regional water development would be accelerated by the more extreme possibilities under the Habitat Conservation Plan. The findings also indicate that a water market would improve regional welfare and lower water development but worsen environmental attributes.

  1. Generalized Lorentz transformation in the general relativity theory and the behaviour of some physical quantities at the boundary of R and T regions

    International Nuclear Information System (INIS)

    Nekrasov, A.G.; Mikhal'chuk, A.A.

    1978-01-01

    Transition between diagonal metrics is considered. The transformations are written in the generalized Lorentz form. On the basis of the thus introduced form of transformations of coordinates the transformations for velocity, acceleration, force, momentum, energy and energy-momentum tensor components have been obtained. The resultant relationships are used for the estimation of physical values at the R and T region boundaries

  2. The Cost-Effectiveness of Spinal Cord Stimulation for Complex Regional Pain Syndrome

    NARCIS (Netherlands)

    Kemler, Marius A.; Raphael, Jon H.; Bentley, Anthony; Taylor, Rod S.

    2010-01-01

    Objectives: Health-care policymakers and payers require cost-effectiveness evidence to inform their treatment funding decisions. The aims of this study were to assess the cost-effectiveness of the addition of spinal cord stimulation (SCS) compared with conventional management alone (CMM) in patients

  3. A unique anesthesia approach for carotid endarterectomy: Combination of general and regional anesthesia

    Directory of Open Access Journals (Sweden)

    Sukhen Samanta

    2014-01-01

    Full Text Available Carotid endarterectomy (CEA, a preventable surgery, reduces the future risks of cerebrovascular stroWke in patients with marked carotid stenosis. Peri-operative management of such patients is challenging due to associated major co-morbidities and high incidence of peri-operative stroke and myocardial infarction. Both general anesthesia (GA and local regional anesthesia (LRA can be used with their pros and cons. Most developing countries as well as some developed countries usually perform CEA under GA because of technical easiness. LRA usually comprises superficial, intermediate, deep cervical plexus block or a combination of these techniques. Deep block, particularly, is technically difficult and more complicated, whereas intermediate plexus block is technically easy and equally effective. We did CEA under a combination of GA and LRA using ropivacaine 0.375% with 1 mcg/kg dexmedetomidine (DEX infiltration. In LRA, we gave combined superficial and intermediate cervical plexus block with infiltration at the incision site and along the lower border of mandible. We observed better hemodynamics in intraoperative as well as postoperative periods and an improved postoperative outcome of the patient. So, we concluded that combination of GA and LRA is a good anesthetic technique for CEA. Larger randomized prospective trials are needed to support our conclusion.

  4. Prevalence and Cost of Full-Time Research Fellowships During General Surgery Residency – A National Survey

    Science.gov (United States)

    Robertson, Charles M.; Klingensmith, Mary E.; Coopersmith, Craig M.

    2009-01-01

    Structured Abstract Objective To quantify the prevalence, outcomes, and cost of surgical resident research. Summary Background Data General surgery is unique among graduate medical education programs because a large percentage of residents interrupt their clinical training to spend 1-3 years performing full-time research. No comprehensive data exists on the scope of this practice. Methods Survey sent to all 239 program directors of general surgery residencies participating in the National Resident Matching Program. Results Response rate was 200/239 (84%). A total of 381 out of 1052 trainees (36%) interrupt residency to pursue full-time research. The mean research fellowship length is 1.7 years, with 72% of trainees performing basic science research. A significant association was found between fellowship length and post-residency activity, with a 14.7% increase in clinical fellowship training and a 15.2% decrease in private practice positions for each year of full-time research (p<0.0001). Program directors at 31% of programs reported increased clinical duties for research fellows as a result of ACGME work hour regulations for clinical residents, while a further 10% of programs are currently considering such changes. It costs $41.5 million to pay the 634 trainees who perform research fellowships each year, the majority of which is paid for by departmental funds (40%) and institutional training grants (24%). Conclusions Interrupting residency to perform a research fellowship is a common and costly practice among general surgery residents. While performing a research fellowship is associated with clinical fellowship training after residency, it is unclear to what extent this practice leads to the development of surgical investigators after post-graduate training. PMID:19106692

  5. Comparison of Turkey’s Geographical Regions in terms of Stand-Alone PV System Design and Cost Parameters

    Directory of Open Access Journals (Sweden)

    Nevzat Onat

    2017-01-01

    Full Text Available Stand-alone photovoltaic (SAPV systems are widely used in rural areas where there is no national grid or as a precaution against power outages. In this study, technical and economic analysis of a SAPV system was carried out using meteorological data for 75 province centers in seven geographical regions of Turkey. Obtained results for each province center were separated by geographical area. The averages of the centers for each region are taken as output. A calculation algorithm based on MsExcel has been established for these operations. The analyses made with the developed algorithm are repeated for five different scenarios that they cover periods of time when a constant strong load is active for all seasons (winter, spring, summer, and autumn and all year round. The developed algorithm calculates the life-cycle cost, the unit energy cost, the electrical capacity utilization rate, the amount of generated/excess energy per month, the initial investment/replacement, and operating and maintenance (O&M costs of each element. As a result, geographical regions of Turkey are compared in terms of these outputs graphically. Further investigations may include the sale of excess energy generated, small-scale PV system cost factors parallel to the grid, and the effects of government incentives.

  6. General interest and investment. Long-term marginal cost and pricing at Electricite de France (1948-1949)

    International Nuclear Information System (INIS)

    Yon, Guillaume

    2014-01-01

    The paper investigates the construction of a concept in economic theory, long-term marginal cost pricing. It does so by exploring the work done within electricite de France in 1948-1949 by a group of engineer-economists who came out with the notion while they were engaged in completely remaking the pricing policy of the new public monopoly. I will show that the concept envisages a large-scale reorganization of the national power generation capacity in order to enact a certain conception of the general interest in the electric sector

  7. A cooperative reduction model for regional air pollution control in China that considers adverse health effects and pollutant reduction costs.

    Science.gov (United States)

    Xie, Yujing; Zhao, Laijun; Xue, Jian; Hu, Qingmi; Xu, Xiang; Wang, Hongbo

    2016-12-15

    How to effectively control severe regional air pollution has become a focus of global concern recently. The non-cooperative reduction model (NCRM) is still the main air pollution control pattern in China, but it is both ineffective and costly, because each province must independently fight air pollution. Thus, we proposed a cooperative reduction model (CRM), with the goal of maximizing the reduction in adverse health effects (AHEs) at the lowest cost by encouraging neighboring areas to jointly control air pollution. CRM has two parts: a model of optimal pollutant removal rates using two optimization objectives (maximizing the reduction in AHEs and minimizing pollutant reduction cost) while meeting the regional pollution control targets set by the central government, and a model that allocates the cooperation benefits (i.e., health improvement and cost reduction) among the participants according to their contributions using the Shapley value method. We applied CRM to the case of sulfur dioxide (SO 2 ) reduction in Yangtze River Delta region. Based on data from 2003 to 2013, and using mortality due to respiratory and cardiovascular diseases as the health endpoints, CRM saves 437 more lives than NCRM, amounting to 12.1% of the reduction under NCRM. CRM also reduced costs by US $65.8×10 6 compared with NCRM, which is 5.2% of the total cost of NCRM. Thus, CRM performs significantly better than NCRM. Each province obtains significant benefits from cooperation, which can motivate them to actively cooperate in the long term. A sensitivity analysis was performed to quantify the effects of parameter values on the cooperation benefits. Results shown that the CRM is not sensitive to the changes in each province's pollutant carrying capacity and the minimum pollutant removal capacity, but sensitive to the maximum pollutant reduction capacity. Moreover, higher cooperation benefits will be generated when a province's maximum pollutant reduction capacity increases. Copyright

  8. Desmodium: A low-cost pasture for the eastern Cape coastal region ...

    African Journals Online (AJOL)

    Keywords: Animal production; Beef production; botany; Desmodium intortum; dryland; east london; Eastern Cape; economic evaluation; fertilizer; grasses; gross margin; Growth requirements; livestock; Management; maximum production; pasture; Pastures; Production costs; south africa; star grass; stocking rate; stocking ...

  9. THE PRODUCTION COSTS OF CONVENTIONAL AND ORGANIC APPLE ORCHARDS IN THE VENETO REGION (ITALY)

    OpenAIRE

    CIMPAN Oana; BEGALLI Diego; CODURRI Stefano

    2012-01-01

    In times of crisis people are thinking how to make the best choice to be more profitable. Both the manufacturers and the consumers must choose the best solutions for them and their businesses. Making a choice between organic and conventional methods in times of crisis is even more difficult considering production costs and consumption patterns. What is the composition of production costs for an apple orchard, how they can be divided into homogeneous categories and why to choose green are the ...

  10. Photovoltaic systems: A cost competitive option to supply energy to off-grid agricultural communities in arid regions

    International Nuclear Information System (INIS)

    Qoaider, Louy; Steinbrecht, Dieter

    2010-01-01

    The main objective of this work is to investigate the economic feasibility of photovoltaic technology to supply the entire energy demands to off-grid irrigated-farming-based communities in the arid regions. This aims at helping these communities to find practical solutions to cope with the rapid rising electricity generation costs, mainly by diesel generators (gensets). The genset electricity costs are typically affected by the high fossil fuel prices, the fuel transport costs and the intensive operation and maintenance (O and M) requirements. The work was conducted on a representative site from which conclusions could be drawn for similar regions. The case study was performed in the New Kalabsha Village in the Lake Nasser Region (LNR) in southern Egypt. The work involved the technical design and the calculation of the life cycle costs (LCC) of a PV system, which is able to supply the village with its entire energy demand. The PV generator was sized in such a way to daily pump 111 000 m 3 of lake water to irrigate 1260 ha acreage plots and to electrify the adjacent village's households. The required pumps were designed to pump the fluctuating lake's water for a maximum differential head of 17 m in four different locations. Consequently, water from the four pumping stations flows freely by gravity forces to the different plots through overhead open canals. The electricity generation costs and the performance of the designed PV generator were compared with those of an equivalent diesel generator (genset) in order to prove its competitiveness. With this regard, the real market value of the diesel fuel of 86.55 c Euro l -1 was considered for calculating the costs of genset generated electricity. The results showed that the genset electricity unit costs 39 c Euro kW h -1 while a unit of PV electricity costs only 13 c Euro kW h -1 for the equivalent system size and project lifetime. Furthermore, the subsidised genset electricity cost was calculated to be 12 c Euro kW h

  11. The implications of regional and national demographic projections for future GMS costs in Ireland through to 2026.

    LENUS (Irish Health Repository)

    Conway, Aisling

    2014-10-21

    As the health services in Ireland have become more resource-constrained, pressure has increased to reduce public spending on community drug schemes such as General Medical Services (GMS) drug prescribing and to understand current and future trends in prescribing. The GMS scheme covers approximately 37% of the Irish population in 2011 and entitles them, inter alia, to free prescription drugs and appliances. This paper projects the effects of future changes in population, coverage, claims rates and average claims cost on GMS costs in Ireland.

  12. Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region.

    Science.gov (United States)

    Pergolotti, Mackenzi; Lavery, Jessica; Reeve, Bryce B; Dusetzina, Stacie B

    This article describes the cost of occupational therapy by provider, insurance status, and geographic region and the number of visits allowed and out-of-pocket costs under proposed therapy caps. This retrospective, population-based study used Medicare Provider Utilization and Payment Data for occupational therapists billing in 2012 and 2013 (Ns = 3,662 and 3,820, respectively). We examined variations in outpatient occupational therapy services with descriptive statistics and the impact of therapy caps on occupational therapy visits and patient out-of-pocket costs. Differences in cost between occupational and physical therapists were minimal. The most frequently billed service was therapeutic exercises. Wisconsin had the most inflated outpatient costs in both years. Under the proposed therapy cap, patients could receive an evaluation plus 12-14 visits. . Wide variation exists in potential patient out-of-pocket costs for occupational therapy services on the basis of insurance coverage and state. Patients without insurance pay a premium. Copyright © 2018 by the American Occupational Therapy Association, Inc.

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

    Science.gov (United States)

    Jacobsen, R; Buysse, J; Gellynck, X

    2013-01-01

    The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. 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.

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

    International Nuclear Information System (INIS)

    Jacobsen, R.; Buysse, J.; Gellynck, X.

    2013-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-01-15

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

  17. Implementation of an electronic surgical referral service. Collaboration, consensus and cost of the surgeon – general practitioner Delphi approach

    Directory of Open Access Journals (Sweden)

    Augestad KM

    2014-09-01

    Full Text Available Knut Magne Augestad,1–3 Arthur Revhaug,1,3 Roar Johnsen,4 Stein-Olav Skrøvseth,2 Rolv-Ole Lindsetmo1,3 1Department of Gastrointestinal Surgery, 2Department of Integrated Care and Telemedicine, University Hospital North Norway, Tromsø, Norway; 3Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA; 4Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Background: Poor coordination between levels of care plays a central role in determining the quality and cost of health care. To improve patient coordination, systematic structures, guidelines, and processes for creating, transferring, and recognizing information are needed to facilitate referral routines. Methods: Prospective observational survey of implementation of electronic medical record (EMR-supported guidelines for surgical treatment. Results: One university clinic, two local hospitals, 31 municipalities, and three EMR vendors participated in the implementation project. Surgical referral guidelines were developed using the Delphi method; 22 surgeons and seven general practitioners (GPs needed 109 hours to reach consensus. Based on consensus guidelines, an electronic referral service supported by a clinical decision support system, fully integrated into the GPs' EMR, was developed. Fifty-five information technology personnel and 563 hours were needed (total cost 67,000 £ to implement a guideline supported system in the EMR for 139 GPs. Economical analyses from a hospital and societal perspective, showed that 504 (range 401–670 and 37 (range 29–49 referred patients, respectively, were needed to provide a cost-effective service. Conclusion: A considerable amount of resources were needed to reach consensus on the surgical referral guidelines. A structured approach by the Delphi method and close collaboration between IT personnel, surgeons and primary care physicians were needed to

  18. Water quality management and climate change mitigation: cost-effectiveness of joint implementation in the Baltic Sea region

    DEFF Research Database (Denmark)

    Nainggolan, Doan; Hasler, Berit; Andersen, Hans Estrup

    2018-01-01

    of contrasting strategies: single environmental objective management versus joint implementation strategy. The results show that implementing land-based measures with a sole focus on water quality (to meet the HELCOM's 2013 Baltic Sea Action Plan nutrient abatement targets) can produce climate change mitigation......This paper explores the scope for simultaneously managing nutrient abatement and climate change mitigation in the Baltic Sea (BS) region through the implementation of a selection of measures. The analysis is undertaken using a cost-minimisation model for the entire BS region, the BALTCOST model....... In the present research, the model has been extended to include greenhouse gas (GHG) emissions effects, enabling us to analyse the tradeoffs between cost-effective GHG and nutrient load reductions. We run the model for four different scenarios in order to compare the environmental and economic consequences...

  19. Considerations for Assessing the Appropriateness of High-Cost Pediatric Care in Low-Income Regions

    Directory of Open Access Journals (Sweden)

    Andrew C. Argent

    2018-03-01

    Full Text Available It may be difficult to predict the consequences of provision of high-cost pediatric care (HCC in low- and middle-income countries (LMICs, and these consequences may be different to those experienced in high-income countries. An evaluation of the implications of HCC in LMICs must incorporate considerations of the specific context in that country (population age profile, profile of disease, resources available, likely costs of the HCC, likely benefits that can be gained versus the costs that will be incurred. Ideally, the process that is followed in decision making around HCC should be transparent and should involve the communities that will be most affected by those decisions. It is essential that the impacts of provision of HCC are carefully monitored so that informed decisions can be made about future provision medical interventions.

  20. CCS in the North Sea region: A comparison on the cost-effectiveness of storing CO2 in the Utsira formation at regional and national scales

    DEFF Research Database (Denmark)

    Strachan, N.; Hoefnagels, R.; Ramirez, A.

    2011-01-01

    The potential scale of carbon dioxide capture and storage (CCS) under long-term decarbonisation scenarios means that analysis on the contribution of large international CO2 storage reservoirs is critical. This paper compares the potentially key role of CCS within cost-optimizing energy systems...... formation as a common North Sea CO2 storage resource. A robust finding is that low carbon electricity is a primary decarbonisation pathway and that CCS plays a key role (32–40%) within this portfolio. This paper confirms that the overall driver of the amount of CCS utilized is the climate policy...... the CO2 storage cost curve, with the Netherlands and the UK being the largest contributors, followed by transboundary flows of CO2 from other countries. However, overall regional CCS flows may be larger (for example under low fossil fuel prices) than the estimated (and uncertain) maximum annual injection...

  1. General practitioners do not systematically adhere to regional recommendations on treatment of uncomplicated urinary tract infections

    DEFF Research Database (Denmark)

    Christoffersen, Thea; Bjerrum, Lars; Nielsen, Anni Brit Sternhagen

    2014-01-01

    INTRODUCTION: Uncomplicated urinary tract infection (uUTI) is a common reason for seeing a GP. In Denmark, it is debated if sulfamethizole or pivmecillinam should be recommended for empirical treatment of uUTIs. We evaluated sulfamethizole and pivmecillinam use in the five Danish regions from 2007...... to 2011 and explored if the choice of antibiotic in primary care was in accordance with the regional recommendations for uUTI. MATERIAL AND METHODS: Regional drug use data on pivmecillinam and sulfamethizole from 2007 to 2011 were retrieved from the Registry of Medicinal Product Statistics. Regional...... recommendations from the same period were identified. We calculated differences in consumption based on defined daily doses per 1,000 inhabitants per day (DID) of pivmecillinam and sulfamethizole between the five regions, and intraregional developments. RESULTS: Four regions had recommendations on uUTI in 2011...

  2. Assessing the full costs of water, liquid waste, energy and solid waste infrastructure in the Fraser Valley Regional District (FVRD)

    International Nuclear Information System (INIS)

    Pollard, D.

    2001-01-01

    This document presents a newly drafted growth strategy developed by the Fraser Valley Regional District (FVRD) in British Columbia. It guides the sustainable growth, change and development of the region for the next 25 years and deals with air pollution, water quality, traffic congestion, affordable housing, employment, energy use, parks and green space. In particular, this case study develops a method to apply full cost accounting (FCA) to a growth strategy. FCA is the most appropriate way to approach a sustainable strategy because it considers economic, social and environmental issues. The study also includes the development of a software tool consisting of an ACCESS database and an ARCVIEW GIS file for compiling and analyzing detailed infrastructure profiles which can be used to assess the full costs of different growth scenarios. The following four issue categories of environmental and economic indicators of FVRD performance were addressed: solid waste, water and wastewater, energy, and infrastructure costs. Each issue category was then used to establish a set of 5 performance indicators that can be measured and assessed over time. These included solid waste, water consumption, wastewater, energy consumption and air emissions. The database and methodology developed for this project is suitable for other regions. The software can be viewed by contacting the Sheltair Group Resource Consultants Inc. in Vancouver

  3. Regional versus General Anesthesia for Percutaneous Nephrolithotomy: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Henglong Hu

    Full Text Available To compare the effectiveness and safety of regional anesthesia (RA and general anesthesia (GA for percutaneous nephrolithotomy (PNL.PubMed, EMBASE, The Cochrane Library, and the Web of Knowledge databases were systematically searched to identify relevant studies. After literature screening and data extraction, a meta-analysis was performed using the RevMan 5.3 software.Eight randomized controlled trials (RCTs and six non-randomized controlled trials (nRCTs involving 2270 patients were included. Patients receiving RA were associated with shorter operative time (-6.22 min; 95%CI, -9.70 to -2.75; p = 0.0005, lower visual analgesic score on the first and third postoperative day (WMD, -2.62; 95%CI, -3.04 to -2.19; p < 0.00001 WMD, -0.38; 95%CI, -0.58 to -0.18; p = 0.0002, less analgesic requirements (WMD, -59.40 mg; 95%CI, -78.39 to -40.40; p<0.00001, shorter hospitalization (WMD, -0.36d; 95%CI, -0.66 to -0.05; p = 0.02, less blood transfusion (RR, 0.61; 95%CI, 0.41 to 0.93; p = 0.02, fewer modified Clavion-Dindo Grade II (RR, 0.56; 95%CI, 0.37 to 0.83; p = 0.005, Grade III or above postoperative complications (RR, 0.51; 95%CI, 0.33 to 0.77; p = 0.001, and potential benefits of less fever (RR, 0.79; 95%CI, 0.61 to 1.02; p = 0.07, nausea or vomiting (RR, 0.54; 95%CI, 0.20 to 1.46; p = 0.23, whereas more intraoperative hypotension (RR, 3.13; 95%CI, 1.76 to 5.59; p = 0.0001 when compared with patients receiving GA. When nRCTs were excluded, most of the results were stable but the significant differences were no longer detectable in blood transfusion, Grade II and more severe complications. No significant difference in the total postoperative complications and stone-free rate were found.Current evidence suggests that both RA and GA can provide safe and effective anesthesia for PNL in carefully evaluated and selected patients. Each anesthesia technique has its own advantages but some aspects still remain unclear and need to be explored in future studies.

  4. Internalisation of external cost in the power generation sector: Analysis with Global Multi-regional MARKAL model

    International Nuclear Information System (INIS)

    Rafaj, Peter; Kypreos, Socrates

    2007-01-01

    The Global MARKAL-Model (GMM), a multi-regional 'bottom-up' partial equilibrium model of the global energy system with endogenous technological learning, is used to address impacts of internalisation of external costs from power production. This modelling approach imposes additional charges on electricity generation, which reflect the costs of environmental and health damages from local pollutants (SO 2 , NO x ) and climate change, wastes, occupational health, risk of accidents, noise and other burdens. Technologies allowing abatement of pollutants emitted from power plants are rapidly introduced into the energy system, for example, desulphurisation, NO x removal, and CO 2 scrubbers. The modelling results indicate substantial changes in the electricity production system in favour of natural gas combined cycle, nuclear power and renewables induced by internalisation of external costs and also efficiency loss due to the use of scrubbers. Structural changes and fuel switching in the electricity sector result in significant reduction of emissions of both local pollution and CO 2 over the modelled time period. Strong decarbonisation impact of internalising local externalities suggests that ancillary benefits can be expected from policies directly addressing other issues then CO 2 mitigation. Finally, the detailed analysis of the total generation cost of different technologies points out that inclusion of external cost in the price of electricity increases competitiveness of non-fossil generation sources and fossil power plants with emission control

  5. Achieving regional fare integration in New Orleans: innovative cost sharing arrangements and technologies.

    Science.gov (United States)

    2015-09-01

    Many regions across the country have more than one transit agency providing vital public transportation : services. While a transit agency may see their role limited by a jurisdictional boundary, transit riders : commutes know no such political bo...

  6. General Systems Theory, Systems Analysis, and Regional Planning: An Introductory Bibliography. Exchange Bibliography No. 164.

    Science.gov (United States)

    Williams, Hugh E.

    This bibliography suggests a number of introductory readings that will enable regional and urban planners to understand the systems approach. The main focus of the research study that gave rise to this review of the literature was on establishing ways in which decisionmakers in regional planning could be helped in making their choices. The…

  7. Problems of Economic Grown in Modern Russia: General Characteristics and Regional Aspect

    Directory of Open Access Journals (Sweden)

    Sergey N. Levin

    2016-12-01

    Full Text Available Authors analyze the problem to find the optimal policy options to stimulate economic growth in modern conditions. They point out three possible options for such policy according to the different structural priorities. This point causes the question of the extent to which the proposed policy approaches to stimulate economic growth correspond to real economic trends. The solution of this problem is possible only on the basis of the empirical study analysis results. Also it is necessary to take into account the regional dimension related to the fact that the various sectors of the economy linked to the various regions. According to this fact one may point out Russian regions with the predominance of the mining industry, manufacturing industry and services. Authors exploit panel dataset on 80 Russian regions for the period 2005-2014 to analyze the relationship between annual shares of sectors in output and employment and per capita gross regional growth. Results indicate that regions with a higher share of manufacturing and mining both in terms of output and employment grow slower during the reporting period. The impact of services on growth is somewhat paradoxical: regions with bigger shares of healthcare and education in output growth faster, but a bigger share of this sector in employment, as much as expanding of the labor share of these sectors impede growth. Possible reason for this paradox is that the high proportion of services in the regions-leaders (especially the share of total employment reflects not the degree of their development, but the development of the public sector in relatively poor regions. The results show that neither manufacturing nor mining and services are not the engines of economic growth that can ensure sustainable development of the whole economy. Authors point out that it is necessary to conduct multivariate policies to stimulate economic growth, which is based on the various configurations of developmental actors

  8. Are Autistic Traits in the General Population Related to Global and Regional Brain Differences?

    Science.gov (United States)

    Koolschijn, P. Cédric M. P.; Geurts, Hilde M.; van der Leij, Andries R.; Scholte, H. Steven

    2015-01-01

    There is accumulating evidence that autistic-related traits in the general population lie on a continuum, with autism spectrum disorders representing the extreme end of this distribution. Here, we tested the hypothesis of a possible relationship between autistic traits and brain morphometry in the general population. Participants completed the…

  9. A Theoretical Assessment of Regional Development Effects on the Demand for General Education

    Science.gov (United States)

    Iwahashi, Roki

    2007-01-01

    This study addresses a prospective aspect of general education: through general education, people obtain information about returns to their future specific education, thereby enabling them to choose fields in which they excel. According to that property of education, this paper presents a theoretical framework as a basis for understanding effects…

  10. National Research Council Dialogue to Assess Progress on NASA's Systems Engineering Cost/Risk Analysis Capability Roadmap Development: General Background and Introduction

    Science.gov (United States)

    Regenie, Victoria

    2005-01-01

    Contents include the following: General Background and Introduction of Capability. Roadmaps for Systems Engineering Cost/Risk Analysis. Agency Objectives. Strategic Planning Transformation. Review Capability Roadmaps and Schedule. Review Purpose of NRC Review. Capability Roadmap Development (Progress to Date).

  11. Calculation of economic viability and environmental costs of photovoltaic solar energy for the Brazilian Northeast region

    International Nuclear Information System (INIS)

    Stecher, Luiza C.; Sabundjian, Gaiane; Menzel, Francine

    2013-01-01

    The availability of energy resources is a central point to economic development. The energy matrix of most countries is based on the consumption of fossil fuels, which adds annually over 5 billion tons of carbon into the atmosphere. The energy consumption in developing countries has quadrupled since the 60s further aggravating global environmental conditions. The need to implement alternative energy sources to the energy matrix was proved. In addition, Brazil has a large number of people without access to electricity, which affects the quality of life of these populations. In this context, it is necessary to think in economic development way, and then the sustainable and alternative sources appear as an option for its features and its availability in Brazil. The solar energy captured by photovoltaic cells can be highlighted in the Brazilian scenario because of its wide availability, especially in the Northeast. The aim of this paper is to estimate the economic feasibility of insertion of solar systems in small communities in the Brazilian Northeast, considering environmental costs involved in electricity generation. The methodology is based on economic concepts and economic valuation of environmental resources. The results shows that solar power is becoming increasingly competitive due to reduced costs of components and due to the environmental costs reduced when compared with fossil fuels. (author)

  12. Benefits, costs, and livelihood implications of a regional payment for ecosystem service program.

    Science.gov (United States)

    Zheng, Hua; Robinson, Brian E; Liang, Yi-Cheng; Polasky, Stephen; Ma, Dong-Chun; Wang, Feng-Chun; Ruckelshaus, Mary; Ouyang, Zhi-Yun; Daily, Gretchen C

    2013-10-08

    Despite broad interest in using payment for ecosystem services to promote changes in the use of natural capital, there are few expost assessments of impacts of payment for ecosystem services programs on ecosystem service provision, program cost, and changes in livelihoods resulting from program participation. In this paper, we evaluate the Paddy Land-to-Dry Land (PLDL) program in Beijing, China, and associated changes in service providers' livelihood activities. The PLDL is a land use conversion program that aims to protect water quality and quantity for the only surface water reservoir that serves Beijing, China's capital city with nearly 20 million residents. Our analysis integrates hydrologic data with household survey data and shows that the PLDL generates benefits of improved water quantity and quality that exceed the costs of reduced agricultural output. The PLDL has an overall benefit-cost ratio of 1.5, and both downstream beneficiaries and upstream providers gain from the program. Household data show that changes in livelihood activities may offset some of the desired effects of the program through increased expenditures on agricultural fertilizers. Overall, however, reductions in fertilizer leaching from land use change dominate so that the program still has a positive net impact on water quality. This program is a successful example of water users paying upstream landholders to improve water quantity and quality through land use change. Program evaluation also highlights the importance of considering behavioral changes by program participants.

  13. Calculation of economic viability and environmental costs of photovoltaic solar energy for the Brazilian Northeast region

    Energy Technology Data Exchange (ETDEWEB)

    Stecher, Luiza C.; Sabundjian, Gaianes; Menzel, Francine, E-mail: luizastecher@usp.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2013-07-01

    The availability of energy resources is a central point to economic development. The energy matrix of most countries is based on the consumption of fossil fuels, which adds annually over 5 billion tons of carbon into the atmosphere. The energy consumption in developing countries has quadrupled since the 60s further aggravating global environmental conditions. The need to implement alternative energy sources to the energy matrix was proved. In addition, Brazil has a large number of people without access to electricity, which affects the quality of life of these populations. In this context, it is necessary to think in economic development way, and then the sustainable and alternative sources appear as an option for its features and its availability in Brazil. The solar energy captured by photovoltaic cells can be highlighted in the Brazilian scenario because of its wide availability, especially in the Northeast. The aim of this paper is to estimate the economic feasibility of insertion of solar systems in small communities in the Brazilian Northeast, considering environmental costs involved in electricity generation. The methodology is based on economic concepts and economic valuation of environmental resources. The results shows that solar power is becoming increasingly competitive due to reduced costs of components and due to the environmental costs reduced when compared with fossil fuels. (author)

  14. Benefits, costs, and livelihood implications of a regional payment for ecosystem service program

    Science.gov (United States)

    Zheng, Hua; Robinson, Brian E.; Liang, Yi-Cheng; Polasky, Stephen; Ma, Dong-Chun; Wang, Feng-Chun; Ruckelshaus, Mary; Ouyang, Zhi-Yun; Daily, Gretchen C.

    2013-01-01

    Despite broad interest in using payment for ecosystem services to promote changes in the use of natural capital, there are few expost assessments of impacts of payment for ecosystem services programs on ecosystem service provision, program cost, and changes in livelihoods resulting from program participation. In this paper, we evaluate the Paddy Land-to-Dry Land (PLDL) program in Beijing, China, and associated changes in service providers’ livelihood activities. The PLDL is a land use conversion program that aims to protect water quality and quantity for the only surface water reservoir that serves Beijing, China’s capital city with nearly 20 million residents. Our analysis integrates hydrologic data with household survey data and shows that the PLDL generates benefits of improved water quantity and quality that exceed the costs of reduced agricultural output. The PLDL has an overall benefit–cost ratio of 1.5, and both downstream beneficiaries and upstream providers gain from the program. Household data show that changes in livelihood activities may offset some of the desired effects of the program through increased expenditures on agricultural fertilizers. Overall, however, reductions in fertilizer leaching from land use change dominate so that the program still has a positive net impact on water quality. This program is a successful example of water users paying upstream landholders to improve water quantity and quality through land use change. Program evaluation also highlights the importance of considering behavioral changes by program participants. PMID:24003160

  15. Regional estimation of rainfall intensity-duration-frequency curves using generalized least squares regression of partial duration series statistics

    DEFF Research Database (Denmark)

    Madsen, H.; Mikkelsen, Peter Steen; Rosbjerg, Dan

    2002-01-01

    A general framework for regional analysis and modeling of extreme rainfall characteristics is presented. The model is based on the partial duration series (PDS) method that includes in the analysis all events above a threshold level. In the PDS model the average annual number of exceedances...

  16. Does anaesthesia cause postoperative cognitive dysfunction? : a randomised study of regional versus general anaesthesia in 438 elderly patients

    NARCIS (Netherlands)

    Rasmussen, L.S.; Johnson, T.; Kuipers, H.M.; Kristensen, D.; Siersma, V.D.; Vila, P.; Jolles, J.; Papaioannou, A.; Abildstrom, H.; Silverstein, J.H.; Bonal, J.A.; Raeder, J.; Nielsen, I.K.; Korttila, K.; Munoz, L.; Dodds, C.; Hanning, C.D.; Moller, J.T.

    2003-01-01

    Keywords:anesthesia;cognitive function;complications;postoperative period;regional anesthesia;surgery Background: Postoperative cognitive dysfunction (POCD) is a common complication after cardiac and major non-cardiac surgery with general anaesthesia in the elderly. We hypothesized that the

  17. Obstetric regional analgesia in the Jesenice General hospital in year 2006

    Directory of Open Access Journals (Sweden)

    Aleksandra Kern

    2007-11-01

    Full Text Available Background: The aim of this retrospective analysis of the obstetric regional analgesia (ORA in Jesenice General Hospital in year 2006 was to evaluate our work and present results. We analysed workload, quality of the analgesia and patients’ satisfaction. We also estimated the OR for vacuum extraction (VE in nulliparous labouring women having ORA. We compared quality of analgesia and total local analgesic consumption in nulliparous women having VE or spontaneous delivery.Methods: We performed retrospective analysis of labours with ORA in year 2006. All women received epiduraly mixture of 0.1 % bupivacaine with 2 µg of fentanyl per ml in intermittent boluses.The labour pain was assessed using visual analogue scale (VAS. We used median and interquartile range to describe distribution of these values and mean with standard deviation to describe distribution of other data (local anaesthetic consumption. We considered patient with pain VAS 3 or less adequately treated, VAS 4 and 5 sufficiently and VAS 6 and more insufficiently treated. We used odds ratio as measurement of risk for VE, t-test for differences in local anaesthetic consumption and Mann-Whitney test to evaluate differences in pain between tested groups.Results: 225 labouring women opted for ORA or 38 % of all labouring women in year 2006. We performed 224 ORA, 59 % during regular work, 41 % during turn of duty. 18 % of ORA were performed between 10 p.m. and 7.00 a.m. In 98 % of cases epidural analgesia was used. Anaesthesiologic work took 16 minutes in average (SD 6.06. Analgesia was started at VAS median 5 (IQR 4–6.5 and at average cervical dilatation 4.1 cm (SD 1.4. Average consumption of bupivacaine was 55 mg (SD 23.7 and fentanyl 91.7 µg (SD 46.5. Most common complications were inadequate analgesia, and misplacement of epidural catheter (10/222, dural tap (6/222, and unilateral analgesia (2/222. 70 labours were ended with VE (13 %; n = 532. There were 27 (8.7 %; n = 309 VE in

  18. Fluid spheres and R- and T-regions in general relativity

    Energy Technology Data Exchange (ETDEWEB)

    McVittie, G C; Wiltshire, R J [Kent Univ., Canterbury (UK)

    1975-10-01

    R- and T-regions of spacetime are first defined in a particular coordinate system and then with the aid of the Schwarzschild vacuum solution are shown to represent the outside and inside of a black hole respectively. A certain class of interior solutions, relating to a perfect fluid, are also considered and it is found that these R- and T-solutions have distinct physical properties. The R-solutions are static, spherically symmetric, permanent, and have a classical analogue, while the corresponding T-solutions, which are wholly time dependent, are cylindrical, temporary, and do not have a classical analogue. It is shown that these T-solutions cannot be generated from their R-region counterparts. Particular T-solutions are also presented in which the corresponding fluid occupies the whole of a T-region. The fluid would under certain circumstances be black body radiation while for other cases the internal pressure is always greater than the density.

  19. Generalization of the World Experience in Differentiation of Regions on Account of Innovation

    Directory of Open Access Journals (Sweden)

    Blahun Ivan S.

    2016-01-01

    Full Text Available One of the main strategic objectives of our State is to promote innovation, which should include development and launch of new products at the national market, development and introduction of new technologies, creation and application of new knowledge. In accordance with the said above, the article has examined the experience of European Union Member States to improve the efficiency of innovation and differentiation of regions in terms of innovation, tools for evaluation of the innovation activity status has been determined in relation to the territories of the European Union at the level of regions.

  20. Manufacturing cost analysis of a parabolic dish concentrator (General Electric design) for solar thermal electric power systems in selected production volumes

    Science.gov (United States)

    1981-01-01

    The manufacturing cost of a General Electric 12 meter diameter concentrator was estimated. This parabolic dish concentrator for solar thermal system was costed in annual production volumes of 100 - 1,000 - 5,000 - 10,000 - 50,000 100,000 - 400,000 and 1,000,000 units. Presented for each volume are the costs of direct labor, material, burden, tooling, capital equipment and buildings. Also presented is the direct labor personnel and factory space requirements. All costs are based on early 1981 economics.

  1. Desalination as Groundwater Conservation: The Cost of Protecting Cultural and Environmental Resources in Chile's Region II

    Science.gov (United States)

    Edwards, E. C.; Cristi, O.; Libecap, G. D.

    2012-12-01

    There is a substantial body of evidence that groundwater overdraft is occurring worldwide. Economists argue that the cause of this overdraft is the open-access nature of the resource, which results in a "tragedy of the commons." Sustainable water management requires that some institution control the resource to limit this overdraft by reducing water extraction. This reduction creates scarcity and requires a method of rationing. The economically efficient outcome occurs when the lowest value uses of water are eliminated. This allocation, though, may have undesirable social consequences, such as the loss of small-scale farming, and political ramifications that make such an allocation unpopular to implement. This paper explores the economic cost of leaving water in low-value uses. The policy we explore is a moratorium on voluntary water sales to mining firms to protect the groundwater resource in northern Chile. This policy has accelerated the use of expensive desalinated water, whose cost is primarily driven by its heavy use of carbon-based electricity. Chile has a strong system of water property rights that economists argue ration water in a way that leads to the efficient allocation through water markets. This paper first explores the potential inefficiency of a water market when groundwater and surface water are linked, as well as when different users vary in their intensity of use. This theoretical background provides a framework for determining the economically efficient allocation of water and the losses associated with the moratorium in northern Chile. The policy does protect some environmental and cultural public goods, which potentially offset some or all of this cost. We provide a perspective on the magnitude of these public goods but do not attempt to value them explicitly. Instead, we demonstrate what their value must be so that the moratorium policy has a cost-to-benefit ratio of one. While the estimate of lost income from inefficiency is the main focus

  2. Leaders or Loners? How Do the BRICS Countries and their Regions Vote in the UN General Assembly

    Directory of Open Access Journals (Sweden)

    Renan Holanda Montenegro

    2017-08-01

    Full Text Available The so-called emerging powers, including the BRICS nations (Brazil, Russia, India, China and South Africa, typically present themselves as natural leaders of their regions. Although physical size confers them the status of regional powers, their role as leaders depends on the consensual acceptance of their would-be followers. Can it be affirmed then that the countries under the influence of the BRICS show convergent positions? Can the five BRICS be considered de facto leaders of their regions? This article sets out to answer these questions by analysing the behaviour of the BRICS and their regional partners in the United Nations General Assembly (UNGA. The research design replicates the data from Voeten (2013 in order to compare the average affinity between each of the BRICS countries and their regions in the votes of the UNGA from 1992 to 2014. The data indicate a high level of regional cohesion for Brazil, China and South Africa when compared to Russia and India. The findings corroborate the literature in relation to Brazil and South Africa but conflict with what has been produced on the regional leadership of Russia, India and China.

  3. Regional disaster impact analysis: comparing Input-Output and Computable General Equilibrium models

    NARCIS (Netherlands)

    Koks, E.E.; Carrera, L.; Jonkeren, O.; Aerts, J.C.J.H.; Husby, T.G.; Thissen, M.; Standardi, G.; Mysiak, J.

    2016-01-01

    A variety of models have been applied to assess the economic losses of disasters, of which the most common ones are input-output (IO) and computable general equilibrium (CGE) models. In addition, an increasing number of scholars have developed hybrid approaches: one that combines both or either of

  4. Bacterial CRISPR Regions: General Features and their Potential for Epidemiological Molecular Typing Studies.

    Science.gov (United States)

    Karimi, Zahra; Ahmadi, Ali; Najafi, Ali; Ranjbar, Reza

    2018-01-01

    CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) loci as novel and applicable regions in prokaryotic genomes have gained great attraction in the post genomics era. These unique regions are diverse in number and sequence composition in different pathogenic bacteria and thereby can be a suitable candidate for molecular epidemiology and genotyping studies. Results:Furthermore, the arrayed structure of CRISPR loci (several unique repeats spaced with the variable sequence) and associated cas genes act as an active prokaryotic immune system against viral replication and conjugative elements. This property can be used as a tool for RNA editing in bioengineering studies. The aim of this review was to survey some details about the history, nature, and potential applications of CRISPR arrays in both genetic engineering and bacterial genotyping studies.

  5. General geology, alteration, and iron deposits in the Palaeoproterozoic Misi region, northern Finland

    Directory of Open Access Journals (Sweden)

    Tero Niiranen

    2003-01-01

    Full Text Available The Paleoproterozoic Misi region forms the northeastern part of the Peräpohja Schist Belt in northern Finland. The area comprises mafic volcanic and sedimentary rocks, differentiated gabbros, and late-orogenic granitoids. Three geochemically different mafic volcanic units were recognised: LREE-depleted amygdaloidal lavas, slightly LREE-enriched lavas, and mafic tuffs that have a flat REE pattern. Sedimentary rocks include arkosites, mica gneisses, dolomitic marbles, quartzites, tuffites, mica schists, calc-silicate rocks and graphite-bearing schists. Two types of gabbros wereidentified: one with a LREE-enriched pattern and another with flat REE pattern. The age of the former is according to Perttunen and Vaasjoki (2001 2117±4 Ma, whereas there is no age determination for the latter. The granitoid intrusions belong to the ca. 1800 Malate-orogenic group of the Central Lapland Granitoid Complex. The geochemistry and the stable isotope data on mafic lavas and dolomitic marbles show similarities with the mafic volcanic rocks and marbles of the lower part of the Kivalo group in the western part of Peräpohja Schist Belt. Peak metamorphic conditions in the region vary from upper-greenschist to upper-amphibolite facies. Three major stages of deformation were distinguished: N-S compressional D1 with ductile deformation, NE-SW compressional D2 with ductile to brittle-ductile deformation, and E-W compressional D3 with brittle deformation. Several magnetite occurrences are known in the region and four of those have been mined for iron. The ores are mainly composed of magnetite with minor haematite, pyrite, chalcopyrite and bornite. Besides iron, the ores contain small amounts of P, S and V aswell as trace amounts of Cu, Co, Te and Au. The magnetite bodies are hosted by skarnoids within the ca. 2220–2120 Ma dolomitic marble-quartzite sequence, and highly differentiated, intensely albitised, LREE-enriched gabbro. Multistage and -type alteration is

  6. Cost-Effectiveness of the 'One4All' HIV Linkage Intervention in Guangxi Zhuang Autonomous Region, China.

    Directory of Open Access Journals (Sweden)

    Xiao Zang

    Full Text Available In Guangxi Zhuang Autonomous Region, China, an estimated 80% of newly-identified antiretroviral therapy (ART-eligible patients are not engaged in ART. Delayed ART uptake ultimately translates into high rates of HIV morbidity, mortality, and transmission. To enhance HIV testing receipt and subsequent treatment uptake in Guangxi, the Chinese Center for Disease Control and Prevention (CDC executed a cluster-randomized trial to assess the effectiveness and cost-effectiveness of a streamlined HIV testing algorithm (the One4All intervention in 12 county-level hospitals.To determine the incremental cost-effectiveness of the One4All intervention delivered at county hospitals in Guangxi, China, compared to the current standard of care (SOC.Health System.1-, 5-and 25-years.We adapted a dynamic, compartmental HIV transmission model to simulate HIV transmission and progression in Guangxi, China and identify the economic impact and health benefits of implementing the One4All intervention in all Guangxi hospitals. The One4All intervention algorithm entails rapid point-of-care HIV screening, CD4 and viral load testing of individuals presenting for HIV screening, with same-day results and linkage to counselling. We populated the model with data from the One4All trial (CTN-0056, China CDC HIV registry and published reports. Model outcomes were HIV incidence, mortality, costs, quality-adjusted life years (QALYs, and the incremental cost-effectiveness ratio (ICER of the One4All intervention compared to SOC.The One4All testing intervention was more costly than SOC (CNY 2,182 vs. CNY 846, but facilitated earlier ART access, resulting in delayed disease progression and mortality. Over a 25-year time horizon, we estimated that introducing One4All in Guangxi would result in 802 averted HIV cases and 1629 averted deaths at an ICER of CNY 11,678 per QALY gained. Sensitivity analysis revealed that One4All remained cost-effective at even minimal levels of effectiveness

  7. Formalization of the General Model of the Green Economy at the Regional Level

    Directory of Open Access Journals (Sweden)

    Ivan Mikhaylovich Potravny

    2016-06-01

    Full Text Available The subject-matter of the article is the research of the problems of economic and mathematical modelling of the green economy at the regional level. The purpose of the research is the substantiation and development of economic and mathematical tools for the modelling of economic and ecological systems at the regional level on the basis of the principles of the green economy. The hypothesis of the study is based on the thesis that in the conditions of the resource exhaustion and depletion of natural capital, the technogenic deposits as well as production waste and consumption can be considered as the resource base for modern production, whose use leads to the elimination of accumulated environmental damage and substitution of natural resources. In the article, the approaches to the system modelling problems are considered to develop the green economy at the level of the country and its regions. The relevance of the transition to a green economy is confirmed by the theoretical and practical research in the field of the cyclic development of socio-eco-economic systems. A number of formalized models and methods for solving current environmental-economic issues including the economic valuation of accumulated environmental damage, eco-economic assessment of the efficiency of natural resource substitution with resource-substitute are proposed as well as the choice of an optimal set of resources-substitutes taking into account the financial and natural resource constraints. The standard models of green growth are considered. These models take into account the exhaustion of natural resources, involvement of the resources of technogenic deposits in the economic circulation through the implementation of investment projects on the elimination of accumulated environmental damage. The results of the study may be used in the different regions of the country for the justification and implementation of investment projects in the framework of the Federal Target

  8. General public knowledge, perceptions and practice towards pharmaceutical drug advertisements in the Western region of KSA.

    Science.gov (United States)

    Al-Haddad, Mahmoud S; Hamam, Fayez; Al-Shakhshir, Sami M

    2014-04-01

    This study aims to examine general public knowledge and behavior toward pharmaceutical advertisements in the Western part of KSA. A cross sectional convenience sampling technique was used in this study. A total of 1445 valid questionnaires were received and analyzed using SPSS version 16 at alpha value of 0.05. Majority of respondents were aware of different types of drugs to be advertised and drug advertisements should seek approval from the health authorities. Television and Internet showed the highest effect on consumers. Almost half of the participants preferred an advertised drug over non-advertised one. Most of the respondents indicated that the quality of frequently advertised drugs is not better than those prescribed by the doctors. Majority of participants had positive beliefs toward advertised drugs concerning their role in education and spreading of awareness among the public. Pharmaceutical advertisements harm the doctor-patient relationship as evidenced by one-third of the investigated sample. Moreover, majority of the participants mentioned that they would consult another doctor or even change the current doctor if he/she refused to prescribe an advertised medication. Results of this study could be used to develop awareness programs for the general public and try to enforce the regulations and policies to protect the general public and patients from the business oriented pharmaceutical companies and drug suppliers.

  9. Adherence to diabetes care processes at general practices in the National Capital Region-Delhi, India

    Directory of Open Access Journals (Sweden)

    Roopa Shivashankar

    2016-01-01

    Full Text Available Aim: To assess the level of adherence to diabetes care processes, and associated clinic and patient factors at general practices in Delhi, India. Methods: We interviewed physicians (n = 23 and patients with diabetes (n = 406, and reviewed patient charts at general practices (government = 5; private = 18. We examined diabetes care processes, specifically measurement of weight, blood pressure (BP, glycated hemoglobin (HbA1c, lipids, electrocardiogram, dilated eye, and a foot examination in the last one year. We analyzed clinic and patient factors associated with a number of care processes achieved using multilevel Poisson regression model. Results: The average number of clinic visits per patient was 8.8/year (standard deviation = 5.7, and physicians had access to patient's previous records in only 19.7% of patients. Dilated eye exam, foot exam, and electrocardiogram were completed in 7.4%, 15.1%, and 29.1% of patients, respectively. An estimated 51.7%, 88.4%, and 28.1% had ≥1 measurement of HbA1c, BP, and lipids, respectively. Private clinics, physician access to patient's previous records, use of nonphysicians, patient education, and the presence of diabetes complication were positively associated with a number of care processes in the multivariable model. Conclusion: Adherence to diabetes care processes was suboptimal. Encouraging implementation of quality improvement strategies like Chronic Care Model elements at general practices may improve diabetes care.

  10. Analysis of energy efficiency and energy consumption costs: a case study for regional wastewater treatment plant in Malaysia

    Directory of Open Access Journals (Sweden)

    Nor Azuana Ramli

    2017-03-01

    Full Text Available The objective of this study is to analyze the possibilities of increasing energy efficiency in the central region wastewater treatment plant by focusing on two aspects: biogas production and prediction of energy production. The analysis is based on one of the biggest central region wastewater treatment plants in Malaysia. After studying the energy efficiency, which consists of optimization of energy consumption and enhancing gas generation, the prediction of power consumption is performed using an autoregressive integrated moving average (ARIMA model. The prediction results are compared with the linear regression method. Comparison shows that even though the total cost of savings is greater by using linear regression, the prediction through ARIMA is more accurate and has smaller root mean square error. The implementation of these two aspects managed to increase energy efficiency by 10% of energy recovery that could further reduce electricity cost and reduction of sludge cake disposal off site. The study recommends other aspects, such as modification in setting up the frequency of variable speed drive for aerators and blowers and optimizing number of feeds into train unit processes within aeration tanks in increasing energy efficiency.

  11. The effect of pricing level to the loss of welfare costs (case study: Indonesia region II water company)

    Science.gov (United States)

    K, B. Rosalina E. W.; Gravitiani, E.; Raharjo, M.; Mulyaningsih, T.

    2018-03-01

    Climate change makes the water balance composition being unstable, both quality and quantity. As a company which responsible for water management, Regional Drinking Water Company (abbreviated as PDAM) is often unable to solve the problem. Welfare costs are indicators to evaluate the economic efficiency. This study aims to calculate the welfare cost of the people lost due to the price determination of PDAM Indonesia in region II with deadweight loss (DWL) approach, so it can provide information to pricing regulator, pricing decision makers and for coIDRorate management. DWL is a loss of economic efficiency that can occur when equilibrium for a good or a service is not achieved, caused by monopoly pricing of artificial scarcity, an externality, a tax or subsidy, or a binding price ceiling or price floor such as a minimum wage. Results showed that the pricing rules set by PDAM yielded different DWL, depending on margin set by the company DWL PDAM ranges between IDR 260,485.66/M3 to IDR 127,486,709.86/M3 which is actually shared to improve the welfare of customers, other communities, and PDAM itself. Data analysis used PDAM performance in 2015 that have not Good CoIDRorate Governance Management and Efficiency.

  12. A Comparison of Inpatient Cost Per Day in General Surgery Patients with Type 2 Diabetes Treated with Basal-Bolus versus Sliding Scale Insulin Regimens.

    Science.gov (United States)

    Phillips, Victoria L; Byrd, Anwar L; Adeel, Saira; Peng, Limin; Smiley, Dawn D; Umpierrez, Guillermo E

    2017-01-01

    The identification of cost-effective glycaemic management strategies is critical to hospitals. Treatment with a basal-bolus insulin (BBI) regimen has been shown to result in better glycaemic control and fewer complications than sliding scale regular insulin (SSI) in general surgery patients with type 2 diabetes mellitus (T2DM), but the effect on costs is unknown. We conducted a post hoc analysis of the RABBIT Surgery trial to examine whether total inpatient costs per day for general surgery patients with T2DM treated with BBI ( n  = 103) differed from those for patients with T2DM treated with SSI ( n  = 99) regimens. Data were collected from patient clinical and hospital billing records. Charges were adjusted to reflect hospital costs. General linearized models were used to estimate the risk-adjusted effects of BBI versus SSI treatment on average total inpatient costs per day. Risk-adjusted average total inpatient costs per day were $US5404. Treatment with BBI compared with SSI reduced average total inpatient costs per day by $US751 (14%; 95% confidence interval [CI] 20-4). Being treated in a university medical centre, being African American or having a bowel procedure or higher-volume pharmacy use significantly reduced costs per day. In general surgery patients with T2DM, a BBI regimen significantly reduced average total hospital costs per day compared with an SSI regimen. BBI has been shown to improve outcomes in a randomized controlled trial. Those results, combined with our findings regarding savings, suggest that hospitals should consider adopting BBI regimens in patients with T2DM undergoing surgery.

  13. Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals.

    Science.gov (United States)

    Pirson, Magali; Martins, Dimitri; Jackson, Terri; Dramaix, Michèle; Leclercq, Pol

    2006-03-01

    This study examined the impact of cost outliers in term of hospital resources consumption, the financial impact of the outliers under the Belgium casemix-based system, and the validity of two "proxies" for costs: length of stay and charges. The cost of all hospital stays at three Belgian general hospitals were calculated for the year 2001. High resource use outliers were selected according to the following rule: 75th percentile +1.5 xinter-quartile range. The frequency of cost outliers varied from 7% to 8% across hospitals. Explanatory factors were: major or extreme severity of illness, longer length of stay, and intensive care unit stay. Cost outliers account for 22-30% of hospital costs. One-third of length-of-stay outliers are not cost outliers, and nearly one-quarter of charges outliers are not cost outliers. The current funding system in Belgium does not penalize hospitals having a high percentage of outliers. The billing generated by these patients largely compensates for costs generated. Length of stay and charges are not a good approximation to select cost outliers.

  14. Effects of different types of anaesthesia (regional vs general) on serum NO and TNF-α levels in surgical patients

    International Nuclear Information System (INIS)

    Li Hong

    2006-01-01

    Objective: To study the effect of anesthesia on changes of serum NO and TNF-α levels in surgical patients. Methods: Serum NO (with biochemical method) and TNF-α (with RIA) levels were determined for 3 times in 31 patients operated under regional anesthesia and 31 patients operated under general anesthesia (both for benign gastric ulcer). The levels were measured before induction of anesthesia, at the beginning of operation, and 1 hr later. Results: In patients under regional anesthesia, both the NO and TNF-α levels increased significantly at the beginning of operation and, 1 hr later, though dropped, remained significantly higher than the levels before induction (P<0.05). NO significant changes of the levels were observed in patients under general anesthesia throughout the operation, and the levels were, as a whole, significantly lower than the levels under regional anesthesia (P<0.05). Conclusion: General anesthesia (combined intravenous and inhalation) could abolish the increase of serum NO and TNF-α levels duning operation. (authors)

  15. [Indicators of general, cerebral, and regional hemodynamics in myopic schoolchildren aged 13-15 years].

    Science.gov (United States)

    Iastrebtseva, T A; Chuprov, A D; Plotnikova, Iu A

    2002-01-01

    110 schoolchildren aged 13-15 years were examined. 24 of them had pseudomyopia and 6 patients myopia of various forms. A control group consisted of 38 children. Central hemodynamics was estimated by average dynamic pressure, cerebral hemodynamics--by rheoencephalography, regional hemodynamics--by dopplerography of the internal carotid and suprapubic arteries. It was found that with myopia progression, the average dynamic pressure positively comes down with reduction of reographic waves amplitude in rheogram. The blood flow rate in internal carotid and suprapubic arteries has no substantial impact on myopia course. Predisposition to arterial hypotension is a risk factor for myopia development and progression.

  16. A general model for the estimation of societal costs of lost production and informal care in Italy

    Directory of Open Access Journals (Sweden)

    Lorenzo Pradelli

    2017-02-01

    reported HRQoL data with demographically matched Italian norms. Our results will be useful for cost-effectiveness and budget impact analyses conducted from the perspective of the Italian society and we encourage the inclusion of these costs in economic evaluations to allow decision makers to be fully informed about the costs and consequences of their decisions on healthcare interventions.

  17. Resource consumption and costs in Dutch patients with Type 2 diabetes mellitus. Results from 29 general practices

    NARCIS (Netherlands)

    Redekop, WK; Koopmanschap, MA; Rutten, GEHM; Wolffenbuttel, BHR; Stolk, RP; Niessen, LW

    Aims The aims of this study were to estimate the costs incurred by Dutch patients with Type 2 diabetes, examine which patient and/or treatment characteristics are associated with costs, and estimate the medical and non-medical costs of patients with Type 2 diabetes in The Netherlands. Methods

  18. Analyze for the Quality Control of General X-ray Systems in Capital region

    International Nuclear Information System (INIS)

    Kang, Byung Sam; Lee, Kang Min; Shin, Woo Yong; Park, Soon Chul; Choi, Hak Dong; Cho, Yong Kwon

    2012-01-01

    Thanks to the rapid increase of the interest in the quality control of the General X-ray systems, this research proposes the direction of the quality control through comparing and inspecting the actual condition of the respective quality control in the Clinic, the educational institution and the hospital. The subjects of the investigation are diagnostic radiation equipment's in the clinic, the educational institution and the hospital around the capital. A test of kVp, mR/mAs out put test and reproducibility of the exposure dose, half value layer, an accordance between the light field and the beam alignment test, and lastly reproducibility of the exposure time. Then the mean difference of the percentage, the CV (Coefficient of Variation, CV) and the attenuated curve which are respectively resulted from the above tests are computed. After that we have evaluated the values according to the regulations on the Diagnostic Radiation Equipment Safety Administration regulations. In the case of the clinic and the educational institution, there were 22 general X-ray devices. And 18.2% of the kVp test, 13.6% of the reproducibility of exposure dose test, 9.1% of the mR/mAs out put test, and 13.6% of the HVL (Half Value Layer) test appeared to be improper. In the case of the hospital, however, there were 28 devices. And 7.1% of the reproducibility of exposure dose, 7.1% of the difference in the light field/ beam alignment, and 7.1% of the reproducibility of the exposure time appeared to be improper. According to the investigation, the hospital's quality control condition is better than the condition in the clinic and the educational institution. The quality control condition of the general X-ray devices in the clinic is unsatisfactory compared to the hospital. Thus, it is considered that realizing the importance of the quality control is necessary.

  19. Radially and azimuthally dependent resonance self-shielding treatment for general multi-region geometry based on a unified theory

    International Nuclear Information System (INIS)

    Koike, Hiroki; Kirimura, Kazuki; Yamaji, Kazuya; Kosaka, Shinya; Yamamoto, Akio

    2018-01-01

    A unified resonance self-shielding method, which can treat general sub-divided fuel regions, is developed for lattice physics calculations in reactor physics field. In a past study, a hybrid resonance treatment has been developed by theoretically integrating equivalence theory and ultra-fine-group slowing-down calculation. It can be applied to a wide range of neutron spectrum conditions including low moderator density ranges in severe accident states, as long as each fuel region is not sub-divided. In order to extend the method for radially and azimuthally sub-divided multi-region geometry, a new resonance treatment is established by incorporating the essence of sub-group method. The present method is composed of two-step flux calculation, i.e. 'coarse geometry + fine energy' (first step) and 'fine geometry + coarse energy' (second step) calculations. The first step corresponds to a hybrid model of the equivalence theory and the ultra-fine-group calculation, and the second step corresponds to the sub-group method. From the verification results, effective cross-sections by the new method show good agreement with the continuous energy Monte-Carlo results for various multi-region geometries including non-uniform fuel compositions and temperature distributions. The present method can accurately generate effective cross-sections with short computation time in general lattice physics calculations. (author)

  20. Streamflow measurements in the oil sands region of northeastern Alberta[General Conference

    Energy Technology Data Exchange (ETDEWEB)

    Ashiq, M.; Ade, F. [Golder Associates Ltd., Calgary, AB (Canada). Water Resources Engineering Group

    2006-07-01

    Oil sands mining in the muskeg terrain of north-eastern Alberta will result in changes to the natural landscape, including changes to the morphology of receiving streams. The streams in the oil sands region are fed by constricted flows through the muskeg terrain. The roughness of the stream is attributed to sporadic cobbles and boulders, in-stream vegetation, over hanging vegetation and large quantities of wooden debris from beaver activities. This paper discussed stream roughness features in the oil sands region and compared the velocity profiles in these streams to the normal channel velocity profile. The study also included a comparison of computed discharges based on a simple method and a detailed method. The sources of errors in velocity measurements were then discussed. It was noted that before any oil sand mining project is approved, flows in receiving streams are monitored as part of the Environment Impact Assessment (EIA). The flows are then monitored again after project approval as part of project approval conditions.

  1. Modeling a farm population to estimate on-farm compliance costs and environmental effects of a grassland extensification scheme at the regional scale

    DEFF Research Database (Denmark)

    Uthes, Sandra; Sattler, Claudia; Piorr, Annette

    2010-01-01

    We used a farm-level modeling approach to estimate on-farm compliance costs and environmental effects of a grassland extensification scheme in the district of Ostprignitz-Ruppin, Germany. The behavior of the regional farm population (n = 585) consisting of different farm types with different...... and environmental effects were heterogeneous in space and farm types as a result of different agricultural production and site characteristics. On-farm costs ranged from zero up to almost 1500 Euro/ha. Such high costs occurred only in a very small part of the regional area, whereas the majority of the grassland had...... low on-farm costs below 50 Euro/ha. Environmental effects were moderate and greater on high-yield than on low-yield grassland. The low effectiveness combined with low on-farm costs in large parts of the region indicates that the scheme is not well targeted. The soft scheme design results from...

  2. Designing a low-cost effective network for monitoring large scale regional seismicity in a soft-soil region (Alsace, France)

    Science.gov (United States)

    Bès de Berc, M.; Doubre, C.; Wodling, H.; Jund, H.; Hernandez, A.; Blumentritt, H.

    2015-12-01

    The Seismological Observatory of the North-East of France (ObSNEF) is developing its monitoring network within the framework of several projects. Among these project, RESIF (Réseau sismologique et géodésique français) allows the instrumentation of broad-band seismic stations, separated by 50-100 km. With the recent and future development of geothermal industrial projects in the Alsace region, the ObSNEF is responsible for designing, building and operating a dense regional seismic network in order to detect and localize earthquakes with both a completeness magnitude of 1.5 and no clipping for M6.0. The realization of the project has to be done prior to the summer 2016Several complex technical and financial constraints constitute such a projet. First, most of the Alsace Région (150x150 km2), particularly the whole Upper Rhine Graben, is a soft-soil plain where seismic signals are dominated by a high frequency noise level. Second, all the signals have to be transmitted in near real-time. And finally, the total cost of the project must not exceed $450,000.Regarding the noise level in Alsace, in order to make a reduction of 40 dB for frequencies above 1Hz, we program to instrument into 50m deep well with post-hole sensor for 5 stations out of 8 plane new stations. The 3 remaining would be located on bedrock along the Vosges piedmont. In order to be sensitive to low-magnitude regional events, we plan to install a low-noise short-period post-hole velocimeter. In order to avoid saturation for high potentiel local events (M6.0 at 10km), this velocimeter will be coupled with a surface strong-motion sensor. Regarding the connectivity, these stations will have no wired network, which reduces linking costs and delays. We will therefore use solar panels and a 3G/GPRS network. The infrastructure will be minimal and reduced to an outdoor box on a secured parcel of land. In addition to the data-logger, we will use a 12V ruggedized computer, hosting a seed-link server for near

  3. A low cost automatic detection and ranging system for space surveillance in the medium Earth orbit region and beyond.

    Science.gov (United States)

    Danescu, Radu; Ciurte, Anca; Turcu, Vlad

    2014-02-11

    The space around the Earth is filled with man-made objects, which orbit the planet at altitudes ranging from hundreds to tens of thousands of kilometers. Keeping an eye on all objects in Earth's orbit, useful and not useful, operational or not, is known as Space Surveillance. Due to cost considerations, the space surveillance solutions beyond the Low Earth Orbit region are mainly based on optical instruments. This paper presents a solution for real-time automatic detection and ranging of space objects of altitudes ranging from below the Medium Earth Orbit up to 40,000 km, based on two low cost observation systems built using commercial cameras and marginally professional telescopes, placed 37 km apart, operating as a large baseline stereovision system. The telescopes are pointed towards any visible region of the sky, and the system is able to automatically calibrate the orientation parameters using automatic matching of reference stars from an online catalog, with a very high tolerance for the initial guess of the sky region and camera orientation. The difference between the left and right image of a synchronized stereo pair is used for automatic detection of the satellite pixels, using an original difference computation algorithm that is capable of high sensitivity and a low false positive rate. The use of stereovision provides a strong means of removing false positives, and avoids the need for prior knowledge of the orbits observed, the system being able to detect at the same time all types of objects that fall within the measurement range and are visible on the image.

  4. The distribution of economic impacts among rural households: A general equilibrium evaluation of regional water policies

    International Nuclear Information System (INIS)

    Wernstedt, K.

    1991-01-01

    This study focuses on the relative distribution among urban and rural household income classes on the economic impacts of two water-related policies in the Columbia River Basin in the northwestern US. The two policies involve: (1) strategies to improve downstream anadromous fish migrations currently hindered by hydropower operations; and (2) proposals to transfer water from irrigation to hydropower generation. A regional input-output model traces the economic effects of the initial demand and price changes through the entire region. The model incorporates price changes in both a short-run (all endogenous prices are fixed) and a longer-run framework based on a Cobb-Douglas representation (all prices can vary). The analysis suggests that the construction of facilities to enhance fish migration and the physical transport of fish have opposite relative effects. The former benefits rural households, while the latter benefits urban households. Electricity price increases resulting from altered hydropower operations harm middle-income rural households, in the short-run. In the longer-run, electricity price increases seem to favor relatively all rural households. Changes associated with the water transfer policy also include electricity price alterations, as well as price and demand changes for agricultural products. Rural households benefit relative to urban households from agricultural product final demand increases, and tend to lose relatively with agricultural price and demand decreases. The inclusion of secondary impacts allows decision makers to asses the income effects of a project across a wider segment of the population, while the incorporation of short-and longer-run economic frameworks allows policy makers to assess both immediate and future income changes

  5. Regional Variation of Cost of Care in the Last 12 Months of Life in Switzerland: Small-area Analysis Using Insurance Claims Data.

    Science.gov (United States)

    Panczak, Radoslaw; Luta, Xhyljeta; Maessen, Maud; Stuck, Andreas E; Berlin, Claudia; Schmidlin, Kurt; Reich, Oliver; von Wyl, Viktor; Goodman, David C; Egger, Matthias; Zwahlen, Marcel; Clough-Gorr, Kerri M

    2017-02-01

    Health care spending increases sharply at the end of life. Little is known about variation of cost of end of life care between regions and the drivers of such variation. We studied small-area patterns of cost of care in the last year of life in Switzerland. We used mandatory health insurance claims data of individuals who died between 2008 and 2010 to derive cost of care. We used multilevel regression models to estimate differences in costs across 564 regions of place of residence, nested within 71 hospital service areas. We examined to what extent variation was explained by characteristics of individuals and regions, including measures of health care supply. The study population consisted of 113,277 individuals. The mean cost of care during last year of life was 32.5k (thousand) Swiss Francs per person (SD=33.2k). Cost differed substantially between regions after adjustment for patient age, sex, and cause of death. Variance was reduced by 52%-95% when we added individual and regional characteristics, with a strong effect of language region. Measures of supply of care did not show associations with costs. Remaining between and within hospital service area variations were most pronounced for older females and least for younger individuals. In Switzerland, small-area analysis revealed variation of cost of care during the last year of life according to linguistic regions and unexplained regional differences for older women. Cultural factors contribute to the delivery and utilization of health care during the last months of life and should be considered by policy makers.

  6. A comparison of the 'cost per child treated' at a primary care-based sedation referral service, compared to a general anaesthetic in hospital.

    Science.gov (United States)

    Jameson, K; Averley, P A; Shackley, P; Steele, J

    2007-09-22

    To compare the cost-effectiveness of dental sedation techniques used in the treatment of children, focusing on hospital-based dental general anaesthetic (DGA) and advanced conscious sedation in a controlled primary care environment. Data on fees, costs and treatment pathways were obtained from a primary care clinic specialising in advanced sedation techniques. For the hospital-based DGA cohort, data were gathered from hospital trusts in the same area. Comparison was via an average cost per child treated and subsequent sensitivity analysis. Analysing records spanning one year, the average cost per child treated via advanced conscious sedation was pound245.47. As some treatments fail (3.5% of cases attempted), and the technique is not deemed suitable for all patients (4-5%), DGA is still required and has been factored into this cost. DGA has an average cost per case treated of pound359.91, 46.6% more expensive than advanced conscious sedation. These cost savings were robust to plausible variation in all parameters. The costs of advanced conscious sedation techniques, applied in a controlled primary care environment, are substantially lower than the equivalent costs of hospital-based DGA, informing the debate about the optimum way of managing this patient group.

  7. The Distinction between Direct and General Costs with Regard to the Deduction of Input VAT - The Case of Acquisition, Holding and Sale of Shares

    DEFF Research Database (Denmark)

    Jensen, Dennis Ramsdahl; Stensgaard, Henrik

    2012-01-01

    of distinguishing between direct and general costs. On the other hand the aim is to describe and analyse the law as it stands regarding the treatment of shares in the EU VAT system, with a special focus on the right to deduct input VAT on costs re-lating to transactions in shares. As a part of this analysis the aim......In revealing the conditions for the deduction of input VAT, the essential questions concern the nature of the so-called ‘direct and immediate link’ test and thus also the criteria for the important distinction between direct costs and general costs. The ‘direct and immediate link’ test...... is of general importance to all types of costs, but judged from the case law of the ECJ it has especially materialised itself when it comes to costs related to the acquisition, holding or sales of shares. The purpose of this article is therefore twofold. On the one hand it deals with the difficult question...

  8. Forecasting how residential urban form affects the regional carbon savings and costs of retrofitting and decentralized energy supply

    International Nuclear Information System (INIS)

    Hargreaves, Anthony; Cheng, Vicky; Deshmukh, Sandip; Leach, Matthew; Steemers, Koen

    2017-01-01

    Highlights: • An innovative model for testing combinations of spatial planning and decentralised energy supply. • An improved method of modelling the spatial variability of energy consumption per dwelling type. • Shows how spatial planning would affect the future carbon reduction of decentralised supply. • Forecasts the future carbon reduction and costs of retrofitting and decentralised supply. • A method of forecasting how residential space would affect the suitability of decentralised supply. - Abstract: Low carbon energy supply technologies are increasingly used at the building and community scale and are an important part of the government decarbonisation strategy. However, with their present state of development and costs, many of these decentralised technologies rely on public subsidies to be financially viable. It is questionable whether they are cost effective compared to other ways of reducing carbon emissions, such as decarbonisation of conventional supply and improving the energy efficiency of dwellings. Previous studies have found it difficult to reliably estimate the future potential of decentralised supply because this depends on the available residential space which varies greatly within a city region. To address this problem, we used an integrated modelling framework that converted the residential density forecasts of a regional model into a representation of the building dimensions and land of the future housing stock. This included a method of estimating the variability of the dwellings and residential land. We present the findings of a case study of the wider south east regions of England that forecasted the impacts of energy efficiency and decentralised supply scenarios to year 2031. Our novel and innovative method substantially improves the spatial estimates of energy consumption compared to building energy models that only use standard dwelling typologies. We tested the impact of an alternative spatial planning policy on the future

  9. Developing a closed-form cost expression for an (R,s,nQ) policy where the demand process is compound generalized Erlang

    DEFF Research Database (Denmark)

    Larsen, Christian; Kiesmüller, Gudrun P.

    We derive a closed-form cost expression for an (R,s,nQ) inventory control policy where all replenishment orders have a constant lead-time, unfilled demand is backlogged and inter-arrival times of order requests are generalized Erlang distributed.......We derive a closed-form cost expression for an (R,s,nQ) inventory control policy where all replenishment orders have a constant lead-time, unfilled demand is backlogged and inter-arrival times of order requests are generalized Erlang distributed....

  10. The influence of patients' complexity and general practitioners' characteristics on referrals to outpatient health services in an Italian region

    Directory of Open Access Journals (Sweden)

    Francesca Valent

    2015-09-01

    Full Text Available BACKGROUND. Patient referrals to outpatient health services may affect both health outcomes and health expenditures. General practitioners (GP have a crucial role in driving the use of outpatient services and recognizing factors which affect referrals is important for health managers and planners. OBJECTIVES. We investigated patient- and physician-related determinants of patient referrals in an Italian region. METHODS. This was cross-sectional study based on the individual linkage of administrative databases from the health information system of the Friuli Venezia Giulia region. For each GP of the region, the association of the number of patient referrals to different types of outpatient services with the proportion of patients with chronic conditions, with the number of hospital admissions and drug prescriptions in 2012, and with GP's characteristics was investigated through multilevel multivariable Poisson regression models. RESULTS. Some chronic conditions (e.g., cancer, autoimmune diseases, endocrine diseases, digestive system diseases were positively associated with the number of referrals, as were hospital admissions and drug prescriptions. Time since GP's graduation was inversely related with referrals. CONCLUSION. Patient complexity and GP's experience affect referral rates. These factors should be considered in case of a reorganization of the general practice structure in Friuli Venezia Giulia.

  11. Improving the thermal integrity of new single-family detached residential buildings: Documentation for a regional database of capital costs and space conditioning load savings

    International Nuclear Information System (INIS)

    Koomey, J.G.; McMahon, J.E.; Wodley, C.

    1991-07-01

    This report summarizes the costs and space-conditioning load savings from improving new single-family building shells. It relies on survey data from the National Association of Home-builders (NAHB) to assess current insulation practices for these new buildings, and NAHB cost data (aggregated to the Federal region level) to estimate the costs of improving new single-family buildings beyond current practice. Space-conditioning load savings are estimated using a database of loads for prototype buildings developed at Lawrence Berkeley Laboratory, adjusted to reflect population-weighted average weather in each of the ten federal regions and for the nation as a whole

  12. Perceptions of primary care staff on a regional data quality intervention in Australian general practice: a qualitative study.

    Science.gov (United States)

    Ghosh, Abhijeet; McCarthy, Sandra; Halcomb, Elizabeth

    2016-04-26

    Technological advances in clinical data capturing and storage systems have led to recent attempts at disease surveillance and region specific population health planning through regularly collected primary care administrative clinical data. However the accuracy and comprehensiveness of primary care health records remain questionable. We aimed to explore the perceptions and experiences of general practice staff in maintaining accurate patient health data within clinical software used in primary care settings of regional NSW. Focus groups were conducted with general practitioners, practice nurses and practice administrative staff from 17 practices in the Illawarra-Shoalhaven region of the state of New South Wales (NSW) in Australia that had participated in the Sentinel Practices Data Sourcing (SPDS) project - a general practice based chronic disease surveillance and data quality improvement study. A total of 25 respondents that included 12 general practitioners (GPs) and 13 practice staff participated in the 6 focus groups. Focus groups were audio-recorded and transcribed verbatim. Thematic analysis of the data was undertaken. Five key themes emerged from the data. Firstly, the theme of resourcing data management raised issues of time constraints, the lack of a dedicated data management role and the importance of multidisciplinary involvement, including a data champion. The need for incentives was identified as being important to motivate ongoing commitment to maintaining data quality. However, quality of software packages, including coding issues and software limitations and information technology skills were seen as key barriers. The final theme provided insight into the lessons learnt from the project and the increased awareness of the importance of data quality amongst practice staff. The move towards electronic methods of maintaining general practice patient records offers significant potential benefits in terms of both patient care and monitoring of health

  13. Calculation of economic viability and environmental costs of biomass from dende oil for small communities of Brazilian northeast region

    International Nuclear Information System (INIS)

    Stecher, Luiza C.; Pacheco, Rafael R.; Sabundjian, Gaiane

    2015-01-01

    The current environmental problems caused by human activity has been gaining attention in society, i.e., as it has influenced in the growth and development of the global economic. The availability of energy resources is central point to economic development and the generation of energy is responsible for a significant portion of the emissions causing the greenhouse effect nowadays. The Brazil, a developing country, still has a large number of people without access to electricity, which affects the quality of life of individuals. In this context, it should think in the sustainable economic development, so the alternative energy sources emerge as an option for power generation. Can highlight biomass as a source in the Brazilian scenario by its wide availability and variety. Therefore, the objective of this work is to estimate the economic viability of the decentralized generation of electricity based on the use of biomass from dende oil in small communities in the Brazilian Northeast considering the environmental costs involved for the source in question. The methodology is based on economic concepts and economic evaluation of environmental resources. The biomass from dende oil was adopted in this work by its characteristics and availability in the studied region. The results show that the generation of energy by biomass from dende oil, it will contribute significantly to the sustainable development of the region, already that it will bring gains environmental, social and financial to society. (author)

  14. Calculation of economic viability and environmental costs of biomass from dende oil for small communities of Brazilian northeast region

    Energy Technology Data Exchange (ETDEWEB)

    Stecher, Luiza C.; Pacheco, Rafael R.; Sabundjian, Gaiane, E-mail: luizastecher@usp.br, E-mail: rafaelrade@gmail.com, E-mail: gdjian@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2015-07-01

    The current environmental problems caused by human activity has been gaining attention in society, i.e., as it has influenced in the growth and development of the global economic. The availability of energy resources is central point to economic development and the generation of energy is responsible for a significant portion of the emissions causing the greenhouse effect nowadays. The Brazil, a developing country, still has a large number of people without access to electricity, which affects the quality of life of individuals. In this context, it should think in the sustainable economic development, so the alternative energy sources emerge as an option for power generation. Can highlight biomass as a source in the Brazilian scenario by its wide availability and variety. Therefore, the objective of this work is to estimate the economic viability of the decentralized generation of electricity based on the use of biomass from dende oil in small communities in the Brazilian Northeast considering the environmental costs involved for the source in question. The methodology is based on economic concepts and economic evaluation of environmental resources. The biomass from dende oil was adopted in this work by its characteristics and availability in the studied region. The results show that the generation of energy by biomass from dende oil, it will contribute significantly to the sustainable development of the region, already that it will bring gains environmental, social and financial to society. (author)

  15. Efficacy and cost effectiveness of telemedicine for improving access to care in the Paris region: study protocols for eight trials.

    Science.gov (United States)

    Charrier, Nathanael; Zarca, Kevin; Durand-Zaleski, Isabelle; Calinaud, Christine

    2016-02-08

    With the development of information and communication technologies, telemedicine has been proposed as a way to improve patient management by facilitating access to appropriate diagnosis and treatment. The Paris Ile de France Regional Health Agency is currently funding a comprehensive program of telemedicine experiments. This article describes the protocols for the evaluation of the implementation of telemedicine in the Paris region. Over 2,500 patients have been included in eight studies addressing the use of telemedicine in the context of specific diseases or settings. Two projects are randomized controlled trials, while the six other projects are based on before-after designs (differences in differences studies). Based on the MAST model and the French national framework, we identified endpoints to assess the impact of telemedicine on five dimensions: clinical effectiveness, cost-effectiveness, security of the application, patient satisfaction and quality of life and perception of professionals. Telemedicine encompasses a wide range of services and stakeholders, and thus study protocols must be tailored to the specific constraints and interests of the users. NCT02110433 (03/07/2014), NCT02157740 (05/27/2014), NCT02374697 (02/05/2015), NCT02157727 (05/27/2014), NCT02229279 (08/28/2014), NCT02368769 (02/05/2015), NCT02164747 (NCT02164747), NCT02309905 (11/27/2014).

  16. Apnea after awake-regional and general anesthesia in infants: The General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnea and neurodevelopmental outcomes, a randomized controlled trial

    Science.gov (United States)

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; de Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen

    2015-01-01

    Background Post-operative apnea is a complication in young infants. Awake-regional anesthesia (RA) may reduce the risk; however the evidence is weak. The General Anesthesia compared to Spinal anesthesia (GAS) study is a randomized, controlled, trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. Methods Infants ≤ 60 weeks postmenstrual age scheduled for inguinal herniorraphy were randomized to RA or GA. Exclusion criteria included risk factors for adverse neurodevelopmental outcome and infants born < 26 weeks’ gestation. The primary outcome of this analysis was any observed apnea up to 12 hours post-operatively. Apnea assessment was unblinded. Results 363 patients were assigned to RA and 359 to GA. Overall the incidence of apnea (0 to 12 hours) was similar between arms (3% in RA and 4% in GA arms, Odds Ratio (OR) 0.63, 95% Confidence Intervals (CI): 0.31 to 1.30, P=0.2133), however the incidence of early apnea (0 to 30 minutes) was lower in the RA arm (1% versus 3%, OR 0.20, 95%CI: 0.05 to 0.91, P=0.0367). The incidence of late apnea (30 minutes to 12 hours) was 2% in both RA and GA arms (OR 1.17, 95%CI: 0.41 to 3.33, P=0.7688). The strongest predictor of apnea was prematurity (OR 21.87, 95% CI 4.38 to 109.24) and 96% of infants with apnea were premature. Conclusions RA in infants undergoing inguinal herniorraphy reduces apnea in the early post-operative period. Cardio-respiratory monitoring should be used for all ex-premature infants. PMID:26001033

  17. Developing a closed-form cost expression for an (R, s, nQ) policy where the demand process is compound generalized Erlang

    DEFF Research Database (Denmark)

    Larsen, Christian; Kiesmüller, G.P

    2007-01-01

    We derive a closed-form cost expression for an (R,s,nQ) inventory control policy where all replenishment orders have a constant lead-time, unfilled demand is back-logged and inter-arrival times of order requests are generalized Erlang distributed. For given values of Q and R we show how to compute...

  18. The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study

    NARCIS (Netherlands)

    Biezen, M.G. van der; Adang, E.M.; Burgt, R. Van Der; Wensing, M.; Laurant, M.G.

    2016-01-01

    BACKGROUND: The pressure in out-of-hours primary care is high due to an increasing demand for care and rising health-care costs. During the daytime, substituting general practitioners (GPs) with nurse practitioners (NPs) shows positive results to contribute to these challenges. However, there is a

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

    Science.gov (United States)

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

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

  20. Estimation of health and economic costs of air pollution over the Pearl River Delta region in China.

    Science.gov (United States)

    Lu, Xingcheng; Yao, Teng; Fung, Jimmy C H; Lin, Changqing

    2016-10-01

    The Pearl River Delta region (PRD) is the economic growth engine of China and also one of the most urbanized regions in the world. As a two-sided sword, rapid economic development causes air pollution and poses adverse health effects to the citizens in this area. This work estimated the negative health effects in the PRD caused by the four major ambient pollutants (SO2, NO2, O3 and PM10) from 2010 to 2013 by using a log linear exposure-response function and the WRF-CMAQ modeling system. Economic loss due to mortality and morbidity was evaluated by the value of statistical life (VSL) and cost of illness (COI) methods. The results show that the overall possible short-term all-cause mortality due to NO2, O3 and PM10 reached the highest in 2013 with the values being 13,217-22,800. The highest total economic loss, which ranged from 14,768 to 25,305million USD, occurred in 2013 and was equivalent to 1.4%-2.3% of the local gross domestic product. The monthly profile of cases of negative health effects varied by city and the types of ambient pollutants. The ratio of mortality attributed to air pollutants to total population was higher in urban areas than in rural areas. People living in the countryside should consider the possible adverse health effects of urban areas before they plan a move to the city. The results show that the health burden caused by the ambient pollutants over this region is serious and suggest that tighter control policies should be implemented in the future to reduce the level of air pollution. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Comparative cost analysis of generalized anxiety disorder and major depressive disorder patients in secondary care from a national hospital registry in Finland.

    Science.gov (United States)

    Kujanpää, Tero; Ylisaukko-Oja, Tero; Jokelainen, Jari; Linna, Miika; Timonen, Markku

    2014-07-01

    Major depressive disorder (MDD) has shown to cause high costs to society. Earlier research indicates that generalized anxiety disorder (GAD) also causes high costs, but only limited data is available in varying settings. To analyse the secondary care costs of GAD compared with those of MDD. Retrospective database analysis from Finnish Hospital Discharge Registers (FHDR). All GAD and MDD patients diagnosed between 1 January 2007 and 31 December 2007 in FHDR were recorded and individual-level secondary care costs during a 48-month follow-up period were measured. The total mean cost of GAD with history of MDD or some other anxiety disorder was significantly higher than that of MDD with history of GAD or some other anxiety disorder during the 48-month follow-up period. The costs of pure GAD were comparable with those of pure MDD, but after adjusting for age and sex, the costs of pure MDD were higher than those of pure GAD. The economic burden of individual GAD patients is comparable with that of MDD patients in secondary care.

  2. Optimization of economic load dispatch of higher order general cost polynomials and its sensitivity using modified particle swarm optimization

    International Nuclear Information System (INIS)

    Saber, Ahmed Yousuf; Chakraborty, Shantanu; Abdur Razzak, S.M.; Senjyu, Tomonobu

    2009-01-01

    This paper presents a modified particle swarm optimization (MPSO) for constrained economic load dispatch (ELD) problem. Real cost functions are more complex than conventional second order cost functions when multi-fuel operations, valve-point effects, accurate curve fitting, etc., are considering in deregulated changing market. The proposed modified particle swarm optimization (PSO) consists of problem dependent variable number of promising values (in velocity vector), unit vector and error-iteration dependent step length. It reliably and accurately tracks a continuously changing solution of the complex cost function and no extra concentration/effort is needed for the complex higher order cost polynomials in ELD. Constraint management is incorporated in the modified PSO. The modified PSO has balance between local and global searching abilities, and an appropriate fitness function helps to converge it quickly. To avoid the method to be frozen, stagnated/idle particles are reset. Sensitivity of the higher order cost polynomials is also analyzed visually to realize the importance of the higher order cost polynomials for the optimization of ELD. Finally, benchmark data sets and methods are used to show the effectiveness of the proposed method. (author)

  3. Patient Dashboard: the use of a colour-coded computerised clinical reminder in Whanganui regional general practices.

    Science.gov (United States)

    McMenamin, John; Nicholson, Rick; Leech, Ken

    2011-12-01

    Clinical reminders have been shown to help general practice achieve an increase in some preventive care items, especially if they identify a patient's eligibility for the target item, prompt clinicians at the right time, provide a fast link to management tools and facilitate clinical recording. WRPHO has introduced the Patient Dashboard clinical reminder and monitored its impact on health targets. This paper reports the impact of a computerised colour-coded clinical reminder on achieving agreed health targets in Whanganui regional practices. Patient Dashboard was developed from previous versions in Auckland and Northland and provided to Whanganui regional practices with Primary Health Organisation (PHO) support. The Dashboard was linked with existing and new clinical management tools which automatically updated clinical records. Data from practices was pooled by Whanganui Regional Primary Health Organisation and target achievement rates reported over 15 months. Over the initial 15 months of Patient Dashboard use, recording of smoking status increased from 74% to 82% and of alcohol use from 15% to 47%. Screening for diabetes increased from 62% to 74%, cardiovascular risk assessment from 20% to 43%, cervical screening from 71% to 79%, and breast screening from 60% to 80%. Patient Dashboard was associated with increased performance indicators both for those targets which were part of a PHO programme and for targets without additional support.

  4. Suicide and general elections in Austria: do preceding regional suicide rate differentials foreshadow subsequent voting behavior swings?

    Science.gov (United States)

    Voracek, Martin; Formann, Anton K; Fülöp, Gerhard; Sonneck, Gernot

    2003-05-01

    Suicide-epidemiological research on short-term effects of elections on national/regional suicide and parasuicide incidence has yielded contradictory evidence. Reversing the cause-effect relationship of this line of research we investigated whether preceding regional suicide rates are related to subsequent election results. For Austria's 121 districts, we regressed averaged standardized suicide rates for the preceding period (1988-1994) on political parties' subsequent electoral gains/losses (1999-to-1995) while controlling for a set of 12 domain-relevant psychosocial/economic indices. Stepwise weighted multiple regression led to a significant model. The 1999-to-1995 electoral gains/losses of two opposition parties, together with the population variation caused by migration balance and by births/deaths balance, accounted for a substantial part (30%) of the variability in preceding district-level suicide rates. Various other social indices failed to contribute further substantial increments to this model. This finding suggests that variations in preceding regional suicide incidence might be mirrored in subsequent changes in voting behavior. A speculative post hoc explanation for the finding is offered: on a community level, suicide's aftermath might produce socially and politically alienated survivors of suicide who co-shape swings towards opposition parties in subsequent general elections. The finding calls for more research on suicide's long-term aftermath. Within-country replicability and cross-national generalizability await further investigation. At present, the factor/mechanism accounting for this finding is neither well-established nor has been directly tested.

  5. Regional Analysis of Building Distributed Energy Costs and CO2 Abatement: A U.S. - China Comparison

    Energy Technology Data Exchange (ETDEWEB)

    Mendes, Goncalo; Feng, Wei; Stadler, Michael; Steinbach, Jan; Lai, Judy; Zhou, Nan; Marnay, Chris; Ding, Yan; Zhao, Jing; Tian, Zhe; Zhu, Neng

    2014-04-09

    The following paper conducts a regional analysis of the U.S. and Chinese buildings? potential for adopting Distributed Energy Resources (DER). The expected economics of DER in 2020-2025 is modeled for a commercial and a multi-family residential building in different climate zones. The optimal building energy economic performance is calculated using the Distributed Energy Resources Customer Adoption Model (DER CAM) which minimizes building energy costs for a typical reference year of operation. Several DER such as combined heat and power (CHP) units, photovoltaics, and battery storage are considered. The results indicate DER have economic and environmental competitiveness potential, especially for commercial buildings in hot and cold climates of both countries. In the U.S., the average expected energy cost savings in commercial buildings from DER CAM?s suggested investments is 17percent, while in Chinese buildings is 12percent. The electricity tariffs structure and prices along with the cost of natural gas, represent important factors in determining adoption of DER, more so than climate. High energy pricing spark spreads lead to increased economic attractiveness of DER. The average emissions reduction in commercial buildings is 19percent in the U.S. as a result of significant investments in PV, whereas in China, it is 20percent and driven by investments in CHP. Keywords: Building Modeling and Simulation, Distributed Energy Resources (DER), Energy Efficiency, Combined Heat and Power (CHP), CO2 emissions 1. Introduction The transition from a centralized and fossil-based energy paradigm towards the decentralization of energy supply and distribution has been a major subject of research over the past two decades. Various concerns have brought the traditional model into question; namely its environmental footprint, its structural inflexibility and inefficiency, and more recently, its inability to maintain acceptable reliability of supply. Under such a troubled setting

  6. Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study.

    Science.gov (United States)

    de Andrés-Nogales, F; Vivancos Mora, J; Barriga Hernández, F J; Díaz Otero, F; Izquierdo Esteban, L; Ortega-Casarrubios, M Á; Castillo Moreno, L; Ximénez-Carrillo Rico, Á; Martín Torres, M P; Gómez-Escalonilla Escobar, C I; Torres González, C; de Salas-Cansado, M; Casado Gómez, M Á; Soto Álvarez, J; Gil-Núñez, A

    2015-01-01

    Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier Espa

  7. The Surface Energy Balance at Local and Regional Scales-A Comparison of General Circulation Model Results with Observations.

    Science.gov (United States)

    Garratt, J. R.; Krummel, P. B.; Kowalczyk, E. A.

    1993-06-01

    Aspects of the mean monthly energy balance at continental surfaces are examined by appeal to the results of general circulation model (GCM) simulations, climatological maps of surface fluxes, and direct observations. Emphasis is placed on net radiation and evaporation for (i) five continental regions (each approximately 20°×150°) within Africa, Australia, Eurasia, South America, and the United States; (ii) a number of continental sites in both hemispheres. Both the mean monthly values of the local and regional fluxes and the mean monthly diurnal cycles of the local fluxes are described. Mostly, GCMs tend to overestimate the mean monthly levels of net radiation by about 15% -20% on an annual basis, for observed annual values in the range 50 to 100 Wm2. This is probably the result of several deficiencies, including (i) continental surface albedos being undervalued in a number of the models, resulting in overestimates of the net shortwave flux at the surface (though this deficiency is steadily being addressed by modelers); (ii) incoming shortwave fluxes being overestimated due to uncertainties in cloud schemes and clear-sky absorption; (iii) land-surface temperatures being under-estimated resulting in an underestimate of the outgoing longwave flux. In contrast, and even allowing for the poor observational base for evaporation, there is no obvious overall bias in mean monthly levels of evaporation determined in GCMS, with one or two exceptions. Rather, and far more so than with net radiation, there is a wide range in values of evaporation for all regions investigated. For continental regions and at times of the year of low to moderate rainfall, there is a tendency for the simulated evaporation to be closely related to the precipitation-this is not surprising. In contrast, for regions where there is sufficient or excessive rainfall, the evaporation tends to follow the behavior of the net radiation. Again, this is not surprising given the close relation between

  8. The cost of geothermal energy in the western US region:a portfolio-based approach a mean-variance portfolio optimization of the regions' generating mix to 2013.

    Energy Technology Data Exchange (ETDEWEB)

    Beurskens, Luuk (ECN-Energy Research Centre of the Netherland); Jansen, Jaap C. (ECN-Energy Research Centre of the Netherlands); Awerbuch, Shimon Ph.D. (.University of Sussex, Brighton, UK); Drennen, Thomas E.

    2005-09-01

    Energy planning represents an investment-decision problem. Investors commonly evaluate such problems using portfolio theory to manage risk and maximize portfolio performance under a variety of unpredictable economic outcomes. Energy planners need to similarly abandon their reliance on traditional, ''least-cost'' stand-alone technology cost estimates and instead evaluate conventional and renewable energy sources on the basis of their portfolio cost--their cost contribution relative to their risk contribution to a mix of generating assets. This report describes essential portfolio-theory ideas and discusses their application in the Western US region. The memo illustrates how electricity-generating mixes can benefit from additional shares of geothermal and other renewables. Compared to fossil-dominated mixes, efficient portfolios reduce generating cost while including greater renewables shares in the mix. This enhances energy security. Though counter-intuitive, the idea that adding more costly geothermal can actually reduce portfolio-generating cost is consistent with basic finance theory. An important implication is that in dynamic and uncertain environments, the relative value of generating technologies must be determined not by evaluating alternative resources, but by evaluating alternative resource portfolios. The optimal results for the Western US Region indicate that compared to the EIA target mixes, there exist generating mixes with larger geothermal shares at equal-or-lower expected cost and risk.

  9. The current prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China.

    Science.gov (United States)

    Zhang, Ying-Xiu; Wang, Zhao-Xia; Zhao, Jin-Shan; Chu, Zun-Hua

    2017-01-15

    Childhood obesity has increased dramatically during the past decades, both in developing and developed countries. The present study examined the prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China. A total of 30,459 students (15,249 boys and 15,210 girls) aged 7-18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The BMI cutoff points recommended by the International Obesity Task Force (IOTF) were used to define general obesity. Central obesity was defined as WHtR≥0.5. Both BMI and WHtR were used to define three types of obesity as follows: general obesity only, central obesity only and combined obesity. The overall prevalences of general obesity only, central obesity only and combined obesity were 10.99, 8.47 and 8.70% for boys and 9.47, 5.12 and 3.19% for girls, respectively. The sum of the prevalence of the three types of obesity was 28.16% for boys and 17.78% for girls, boys had higher prevalence of obesity than girls (Pobesity, children and adolescents from urban, coastal and high socioeconomic status (SES) districts showed a higher prevalence of obesity than their counterparts from rural, inland and low SES districts (Pobesity in children and adolescents has become an important public health concern. Results from this study also suggested that the additional measurement of WC (WHtR) is better than BMI alone to identify obese individuals, distinguishing the types of obesity and examining the prevalence of various types of obesity is useful in practice. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Refinement of motion correction strategies for lower-cost CT for under-resourced regions of the world

    Science.gov (United States)

    Wells, Jered R.; Segars, W. Paul; Kigongo, Christopher J. N.; Dobbins, James T., III

    2011-03-01

    This paper describes a recently developed post-acquisition motion correction strategy for application to lower-cost computed tomography (LCCT) for under-resourced regions of the world. Increased awareness regarding global health and its challenges has encouraged the development of more affordable healthcare options for underserved people worldwide. In regions such as sub-Saharan Africa, intermediate level medical facilities may serve millions with inadequate or antiquated equipment due to financial limitations. In response, the authors have proposed a LCCT design which utilizes a standard chest x-ray examination room with a digital flat panel detector (FPD). The patient rotates on a motorized stage between the fixed cone-beam source and FPD, and images are reconstructed using a Feldkamp algorithm for cone-beam scanning. One of the most important proofs-of-concept in determining the feasibility of this system is the successful correction of undesirable motion. A 3D motion correction algorithm was developed in order to correct for potential patient motion, stage instabilities and detector misalignments which can all lead to motion artifacts in reconstructed images. Motion will be monitored by the radiographic position of fiducial markers to correct for rigid body motion in three dimensions. Based on simulation studies, projection images corrupted by motion were re-registered with average errors of 0.080 mm, 0.32 mm and 0.050 mm in the horizontal, vertical and depth dimensions, respectively. The overall absence of motion artifacts in motion-corrected reconstructions indicates that reasonable amounts of motion may be corrected using this novel technique without significant loss of image quality.

  11. Life satisfaction, general well-being and costs of treatment for severe fear of childbirth in nulliparous women by psychoeducative group or conventional care attendance.

    Science.gov (United States)

    Rouhe, Hanna; Salmela-Aro, Katariina; Toivanen, Riikka; Tokola, Maiju; Halmesmäki, Erja; Saisto, Terhi

    2015-05-01

    Fear of childbirth is a common reason for seeking cesarean section. It is important to consider outcomes and costs associated with alternative treatment and delivery mode. We compared well-being and costs of group psychoeducation and conventional care for fear of childbirth. Randomized controlled trial. A total of 371 nulliparous women scoring over the 95th centile in the Wijma Delivery Expectancy Questionnaire (W-DEQ) during the first trimester. Finland, data from obstetrical patient records and questionnaires. Randomization to group psychoeducation with relaxation (six sessions during pregnancy, one after childbirth, n = 131), or surveillance and referral on demand (n = 240). All costs in maternity care during pregnancy, delivery and postnatally according to Diagnoses Related Groups. Life satisfaction and general well-being 3 months after childbirth (by a Satisfaction with Life Scale and Well-being Visual Analogue Scale). The groups did not differ in total direct costs (€3786/woman in psychoeducative group and €3830/woman in control group), nor in life satisfaction or general well-being. Although only 76 (30%) of the women assigned to the surveillance were referred to special maternity care and 36 (15%) attended advanced prenatal classes, costs in the psychoeducation group did not exceed the costs of the controls, mostly because of the greater number of uncomplicated vaginal deliveries (63% vs. 47%, p = 0.005). Through an association with safer childbirth and equal well-being after delivery, psychoeducative group treatment for nulliparous women with fear of childbirth can be a recommended choice for the same overall costs as conventional treatment. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV infection: a general trend

    Directory of Open Access Journals (Sweden)

    Frédéric Gervais

    2017-03-01

    Full Text Available Abstract Background Due to the arrival of multi-valent HPV vaccines, it is more and more important to have a better understanding of the relationship between vaccination and screening programmes. This review aimed to: (1 collect published evidence on the cost-effectiveness profile of different HPV prevention strategies and, in particular, those combining vaccination with changes in screening practices; (2 explore the cost-effectiveness of alternative preventive strategies based on screening and vaccination. Methods A systematic literature review was conducted in order to identify the relevant studies regarding the cost-effectiveness of prevention strategies against HPV infection. Analysis comparing the modelling approaches between studies was made along with an assessment of the magnitude of impact of several factors on the cost-effectiveness of different screening strategies. Results A total of 18 papers were quantitatively summarised within the narrative. A high degree of heterogeneity was found in terms of how HPV prevention strategies have been assessed in terms of their economic and epidemiological impact, with variation in screening practice and valence of HPV vaccination found to have large implications in terms of cost-effectiveness. Conclusions This review demonstrated synergies between screening and vaccination. New prevention strategies involving multi-valence vaccination, HPV DNA test screening, delayed commencement and frequency of screening could be implemented in the future. Strategies implemented in the future should be chosen with care, and informed knowledge of the potential impact of all possible prevention strategies. Highlighted in this review is the difficulty in assessing multiple strategies. Appropriate modelling techniques will need to be utilised to assess the most cost-effective strategies.

  13. Estudio general de la region del Lago Titicaca evaluando en forma preliminar un sistema de analisis interactivo de imagenes multiespectrales

    Science.gov (United States)

    Brockmann, C.E.; Carter, William D.

    1976-01-01

    ERTS-1 digital data in the form of computer compatible tapes provide the geoscientist with an unusual opportunity to test the maximum flexibility of the satellite system using interactive computers, such as the General Electric Image 100 System. Approximately 9 hours of computer and operator time were used to analyze the Lake Titicaca image, 1443-14073, acquired 9 October 1973. The total area of the lake and associate wetlands was calculated and found to be within 3 percent of previous measurements. The area was subdivided by reflectance characteristics employing cluster analysis of all 4 bands and later compared with density values of band 4. Reflectance variations may be attributed to surface roughness, water depth and bottom characteristics, turbidity, and floating matter. Wetland marsh vegetation, vegetation related to ground-water effluents, natural grasses, and farm crops were separated by cluster analysis. Sandstone, limestone, sand dunes, and several volcanic rock types were similarly separated and displayed by assigned colors and extended through the entire scene. Waste dumps of the Matilde Zinc Mine and smaller mine workings were tentatively identified by signature analysis. Histograms of reflectance values and map printouts were automatically obtained as a record of each of the principal themes. These themes were also stored on a work tape for later display and photographic record as well as to serve in training. The Image 100 System is rapid, extremely flexible and very useful to the investigator in identifying subtle features that may not be noticed by conventional image analysis. The entire scene, which covers 34,225 km2, was analyzed at a scale of 1:600,000, and portions at 1:98,000 and 1:25,000, during a 9-hour period at a rental cost of $250 per hour. Costs to the user can be reduced by restricting its uses to specific areas, objectives, and procedures, rather than undertaking a complete analysis of a total scene.

  14. Analysis of a general circulation model product. I - Frontal systems in the Brazil/Malvinas and Kuroshio/Oyashio regions

    Science.gov (United States)

    Garzoli, Silvia L.; Garraffo, Zulema; Podesta, Guillermo; Brown, Otis

    1992-01-01

    The general circulation model (GCM) of Semtner and Chervin (1992) is tested by comparing the fields produced by this model with available observations in two western boundary current regions, the Brazil/Malvinas and the Kuroshio/Oyashio confluences. The two sets of data used are the sea surface temperature from satellite observations and the temperature field product from the GCM at levels 1 (12.5 m), 2 (37.5 m), and 6 (160 m). It is shown that the model reproduces intense thermal fronts at the sea surface and in the upper layers (where they are induced by the internal dynamics of the model). The location of the fronts are reproduced in the model within 4 to 5 deg, compared with observations. However, the variability of these fronts was found to be less pronounced in the model than in the observations.

  15. Generalized indices of a typical individual water-heating solar plant in the climatic conditions of Russia different regions

    International Nuclear Information System (INIS)

    Popel', O.S.; Frid, S.E.; Shpil'rajn, Eh.Eh.

    2003-01-01

    By the example of the typical solar water-heating plant (SWP), designed for daily consumption of 100 l of heated water the calculation of the number of days in the year is accomplished, during which such a plant could provide for heating the water not below the assigned control level of 37, 45 and 55 deg C for various ratios between the solar collector square and tank-accumulator volume. The generalized dependences are obtained on the basis of processing the results of the SWP dynamic modeling with application of the typical meteoyears, generated for the climatic conditions of more than 40 populated localities in Russia both in its European and Asian part. The efficiency of the SWP operation in different regions of the country may be determined through their application [ru

  16. Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database

    Directory of Open Access Journals (Sweden)

    Reed C

    2013-01-01

    Full Text Available Catherine Reed,1 Jihyung Hong,2 Diego Novick,1 Alan Lenox-Smith,3 Michael Happich41Global Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, UK; 2Personal Social Services Research Unit, London School of Economics and Political Science, London, UK; 3Eli Lilly UK, Basingstoke, UK; 4Eli Lilly and Company, Bad Homburg, GermanyPurpose: To assess the impact of pain severity and time to diagnosis of depression on health care costs for primary care patients with pre-existing unexplained pain symptoms who subsequently received a diagnosis of depression.Patients and methods: This retrospective cohort study analyzed 4000 adults with unexplained pain (defined as painful physical symptoms [PPS] without any probable organic cause and a subsequent diagnosis of depression, identified from the UK General Practice Research Database using diagnostic codes. Patients were categorized into four groups based on pain severity (milder or more severe; based on number of pain-relief medications and use of opioids and time to diagnosis of depression (≤1 year or >1 year from PPS index date. Annual health care costs were calculated (2009 values and included general practitioner (GP consultations, secondary care referrals, and prescriptions for pain-relief medications for the 12 months before depression diagnosis and in the subsequent 2 years. Multivariate models of cost included time period as a main independent variable, and adjusted for age, gender, and comorbidities.Results: Total annual health care costs before and after depression diagnosis for the four patient groups were higher for the groups with more severe pain (£819–£988 versus £565–£628; P < 0.001 for all pairwise comparisons and highest for the group with more severe pain and longer time to depression diagnosis in the subsequent 2 years (P < 0.05. Total GP costs were highest in the group with more severe pain and longer time to depression diagnosis both before and after depression diagnosis (P

  17. ANALYSIS OF COST STRUCTURE FOR PHARMACOTHERAPY OF PATIENTS WITH STABLE ANGINA (THE CASE OF CARDIOLOGY DEPARTMENT OF TVER REGIONAL CLINICAL HOSPITAL

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    M. A. Demidova

    2012-01-01

    Full Text Available Aim. To analyze the cost structure for pharmacotherapy of patients with stable angina (SA, in particular, to compare the cost of pharmacotherapy with drugs, both included and not included into the official Standard of care (SC. Material and methods. Medical records of patients with SA (n=100 admitted to the cardiology department of Tver Regional Clinical Hospital in January-July 2010 were studied retrospectivelly. Costs of treatment with drugs specified in SC for patients with SA as well as drugs not included in SC were considered. Costs of pharmacotherapy and cost structure were determined. Pharmacoeconomical methods, especially ABC analysis, were partially used.  Results. Totally 65502.39 ruble was spent for pharmacotherapy of 100 patients with SA. Cost structure was the following: 32679.34 ruble was spent for drugs recommended by SC, 23698.18 ruble — for drugs not included in SC, and 9124.87 ruble — for drugs to treat concomitant diseases which are not taken into account by SC for patients with SA. Conclusion. SA pharmacotherapy counts 50% of the total cost for drugs recommended by SC, 36% — for drugs not included in SC but belonged to pharmacological class presented in SC, and 14% — drugs from pharmacological class not included in SC. In the process of new SC elaboration for SA patients it is necessary to take into account treatment costs of concomitant diseases especially diabetes mellitus which can account up to 9.5% of total treatment cost of SA patients.

  18. The Hazardous-Drums Project: A Multiweek Laboratory Exercise for General Chemistry Involving Environmental, Quality Control, and Cost Evaluation

    Science.gov (United States)

    Hayes, David; Widanski, Bozena

    2013-01-01

    A laboratory experiment is described that introduces students to "real-world" hazardous waste management issues chemists face. The students are required to define an analytical problem, choose a laboratory analysis method, investigate cost factors, consider quality-control issues, interpret the meaning of results, and provide management…

  19. [Cost-effectiveness and cost-benefit analysis on the integrated schistosomiasis control strategies with emphasis on infection source in Poyang Lake region].

    Science.gov (United States)

    Lin, Dan-Dan; Zeng, Xiao-Jun; Chen, Hong-Gen; Hong, Xian-Lin; Tao, Bo; Li, Yi-Feng; Xiong, Ji-Jie; Zhou, Xiao-Nong

    2009-08-01

    To evaluate the cost-effectiveness and cost-benefit on the integrated schistosomiasis control strategies with emphasis on infection source, and provide scientific basis for the improvement of schistosomiasis control strategy. Aiguo and Xinhe villages in Jinxian County were selected as intervention group where the new comprehensive strategy was implemented, while Ximiao and Zuxi villages in Xinzi County served as control where routine control program was implemented. New strategy of interventions included removing cattle from snail-infested grasslands and providing farmers with farm machinery, improving sanitation by supplying tap water and building lavatories and methane gas tanks, and implementing an intensive health education program. Routine interventions were carried out in the control villages including diagnosis and treatment for human and cattle, health education, and focal mollusciciding. Data were collected from retrospective investigation and field survey for the analysis and comparison of cost-effectiveness and cost-benefit between intervention and control groups. The control effect of the intervention group was better than that of the control. The cost for 1% decrease of infection rate per 100 people, 100 cattle, and 100 snails in intervention group was 480.01, 6 851.24, and 683.63 Yuan, respectively, which were about 2.70, 4.37 and 20.25 times as those in the control respectively. The total cost/benefit ratio (BCR) was lower than 1 (0.94 in intervention group and 0.08 in the control). But the total benefit of intervention group was higher than that of the control from 2005 to 2008. The forecasting analysis indicated that the total BCR in intervention group would be 1.13 at the 4th year and all cost could be recalled. Sensitivity analysis revealed that the BCR in intervention group changed in the range around 1.0 and that of the control ranged blow 0.5. The cost-benefit of intervention group was evidently higher than that of the control. The integrated

  20. Computational Model of D-Region Ion Production Caused by Energetic Electron Precipitations Based on General Monte Carlo Transport Calculations

    Science.gov (United States)

    Kouznetsov, A.; Cully, C. M.

    2017-12-01

    During enhanced magnetic activities, large ejections of energetic electrons from radiation belts are deposited in the upper polar atmosphere where they play important roles in its physical and chemical processes, including VLF signals subionospheric propagation. Electron deposition can affect D-Region ionization, which are estimated based on ionization rates derived from energy depositions. We present a model of D-region ion production caused by an arbitrary (in energy and pitch angle) distribution of fast (10 keV - 1 MeV) electrons. The model relies on a set of pre-calculated results obtained using a general Monte Carlo approach with the latest version of the MCNP6 (Monte Carlo N-Particle) code for the explicit electron tracking in magnetic fields. By expressing those results using the ionization yield functions, the pre-calculated results are extended to cover arbitrary magnetic field inclinations and atmospheric density profiles, allowing ionization rate altitude profile computations in the range of 20 and 200 km at any geographic point of interest and date/time by adopting results from an external atmospheric density model (e.g. NRLMSISE-00). The pre-calculated MCNP6 results are stored in a CDF (Common Data Format) file, and IDL routines library is written to provide an end-user interface to the model.

  1. Regional anesthesia as an alternative to general anesthesia for abdominal surgery in patients with severe pulmonary impairment.

    Science.gov (United States)

    Savas, Jeannie F; Litwack, Robert; Davis, Kevin; Miller, Thomas A

    2004-11-01

    It is known that smokers and patients with chronic obstructive pulmonary disease (COPD) experience a higher rate of pulmonary-related complications following abdominal surgery. The impact of anesthetic technique (regional [RA] versus general [GA] versus combination of both) on the complication rate has not been established. This study examined the outcomes of abdominal surgery performed using RA (epidural or continuous spinal) as the sole anesthetic technique in patients with severe pulmonary impairment (SPI). We reviewed a series of 8 general surgery cases performed using RA alone (T4-T6 sensory level) in patients with SPI, as evidenced by an forced expiratory volume in 1 second (FEV(1)) less than 50% predicted and/or home oxygen requirement. One patient also received postoperative epidural analgesia. FEV(1) ranged from 0.3 to 1.84 L; 3 patients required home oxygen therapy, and 5 of the 8 were American Society of Anesthesiology (ASA) class 4. Operations included segmental colectomy (n = 2), open cholecystectomy (n = 1), incisional herniorrhaphy (n = 1), and laparoscopic herniorrhaphy (n = 4). Intraoperative conditions were adequate with RA alone for successful completion of the procedure in all cases. All patients recovered uneventfully except for 1 who developed postoperative pneumonia that resolved with standard therapy. Length of stay was less than 24 hours for 5 of 8 patients. Mortality was 0%. Abdominal surgery can be safely performed using RA alone in selected high-risk patients, making this option an attractive alternative to GA for those with severe pulmonary impairment.

  2. [The general practitioners in front of reforms: the reactions of the sample group of liberal physicians of the region PACA].

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    Videau, Yann; Ventelou, Bruno; Combes, Jean-Baptiste; Verger, Pierre; Paraponaris, Alain

    2007-05-01

    The general practitioners in front of reforms: the reactions of the sample group of liberal physicians of the region PACA This article intends to analyse the opinion of general practioners (GPs) about the two laws of July 2004, relating to the health insurance reform and to public health planning. We used a panel data sample of 528 GPs practising in Provence Alpes Côte d'Azur in order to analyse the determinants of physicians' adherence to the reform, using multinomial logistic regression models. The results show that GPs do not seem to be fully convinced by this reform (45% agree with it, whereas 48% don't): this mistrustful opinion is more marked for young physicians and appears little correlated with their practices. 75% of the GPs are favourable to the Personal Medical File (Dossier Médical Personnel in french) and 76% estimate that they should draw a better attention to the public health dimension of their practice. Two barriers concerning GPs' adherence to the doctor > reform (réforme du ) seem relevant: the burden of administrative tasks and the disadvantage of young physicians who have not already fixed their own clientele.

  3. Impact of absorbing aerosols on the simulation of climate over the Indian region in an atmospheric general circulation model

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    A. Chakraborty

    2004-04-01

    Full Text Available The impact of anthropogenic absorbing aerosols (such as soot on the climate over the Indian region has been studied using the NCMRWF general circulation model. The absorbing aerosols increase shortwave radiative heating of the lower troposphere and reduce the heating at the surface. These effects have been incorporated as heating of the lower troposphere (up to 700hPa and cooling over the continental surface based on INDOEX measurements. The heating effect is constant in the pre-monsoon season and reduces to zero during the monsoon season. It is shown that even in the monsoon season when the aerosol forcing is zero, there is an overall increase in rainfall and a reduction in surface temperature over the Indian region. The rainfall averaged over the Tropics shows a small reduction in most of the months during the January to September period. The impact of aerosol forcing, the model's sensitivity to this forcing and its interaction with model-physics has been studied by changing the cumulus parameterization from the Simplified Arakawa-Schubert (SAS scheme to the Kuo scheme. During the pre-monsoon season the major changes in precipitation occur in the oceanic Inter Tropical Convergence Zone (ITCZ, where both the schemes show an increase in precipitation. This result is similar to that reported in Chung2002. On the other hand, during the monsoon season the changes in precipitation in the continental region are different in the SAS and Kuo schemes. It is shown that the heating due to absorbing aerosols changes the vertical moist-static stability of the atmosphere. The difference in the precipitation changes in the two cumulus schemes is on account of the different responses in the two parameterization schemes to changes in vertical stability. Key words. Atmospheric composition and structure (aerosols and particles – Meteorology and atmospheric dynamics (tropical meteorology; precipitation

  4. Body Condition Scores and Evaluation of Feeding Habits of Dogs and Cats at a Low Cost Veterinary Clinic and a General Practice

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    Stephanie A. Sapowicz

    2016-01-01

    Full Text Available This study assessed body condition scores (BCS and feeding habits for dogs and cats. Eighty-six cats and 229 dogs (and their owners were enrolled from 2 clinics: a low cost clinic (n=149 and a general practice (n=166. BCS and body weight were recorded. Owners completed a survey which included animal age, sex, and breed; owner demographics; and feeding practices (e.g., diet, rationale for feeding practices. Owners from the low cost clinic had a significantly lower income (P<0.001 and education (P<0.001 compared to those from the general practice. Animals from the low cost clinic were younger (P<0.001 and dogs were less likely to be neutered (P<0.001. Overweight prevalence was 55% overall (P=0.083, with a significantly higher prevalence in the general practice for cats (44% versus 66%; P=0.046, but not for dogs (58% versus 53%; P=0.230. Multivariate analysis showed that only neuter status was significantly associated with BCS (P=0.004. Veterinarians were the most common source of nutritional information, though lack of accurate nutrition knowledge was common among all participants. These findings support the need for enhanced communication about optimal BCS and nutrition regardless of socioeconomic status.

  5. [Estimation of economic costs for the care of patients with nosocomial pneumonia in a regional peruvian hospital, 2009-2011].

    Science.gov (United States)

    Dámaso-Mata, Bernardo; Chirinos-Cáceres, Jesús; Menacho-Villafuerte, Luz

    2016-06-01

    To estimate and compare the economic costs for the care of patients with and without nosocomial pneumonia at Hospital II Huánuco EsSalud during 2009-2011, in Peru. This was a partial economic evaluation of paired cases and controls. A collection sheet was used. nosocomial pneumonia. direct health costs, direct non-health costs, indirect costs, occupation, age, comorbidities, sex, origin, and education level. A bivariate analysis was performed. Forty pairs of cases and controls were identified. These patients were hospitalized for >2 weeks and prescribed more than two antibiotics. The associated direct health costs included those for hospitalization, antibiotics, auxiliary examinations, specialized assessments, and other medications. The direct non-health costs and associated indirect costs included those for transportation, food, housing, foregone payroll revenue, foregone professional fee revenue, extra-institutional expenses, and payment to caregivers during hospitalization and by telephone. The direct health costs for nosocomial pneumonia patients were more than three times and the indirect costs were more than two times higher than those for the controls. Variables with the greatest impact on costs were identified.

  6. Clinicians' adherence versus non adherence to practice guidelines in the management of patients with sarcoma: a cost-effectiveness assessment in two European regions

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    Perrier Lionel

    2012-03-01

    Full Text Available Abstract Background Although the management of sarcoma is improving, non adherence to clinical practice guidelines (CPGs remains high, mainly because of the low incidence of the disease and the variety of histological subtypes. Since little is known about the health economics of sarcoma, we undertook a cost-effectiveness analysis (within the CONnective TIssue CAncer NETwork, CONTICANET comparing costs and outcomes when clinicians adhered to CPGs and when they did not. Methods Patients studied had a histological diagnosis of sarcoma, were older than 15 years, and had been treated in the Rhône-Alpes region of France (in 2005/2006 or in the Veneto region of Italy (in 2007. Data collected retrospectively for the three years after diagnosis were used to determine relapse free survival and health costs (adopting the hospital's perspective and a microcosting approach. All costs were expressed in euros (€ at their 2009 value. A 4% annual discount rate was applied to both costs and effects. The incremental cost-effectiveness ratio (ICER was expressed as cost per relapse-free year gained when management was compliant with CPGs compared with when it was not. To capture uncertainty surrounding ICER, a probabilistic sensitivity analysis was performed based on a non-parametric bootstrap method. Results A total of 219 patients were included in the study. Compliance with CPGs was observed for 118 patients (54%. Average total costs reached 23,571 euros when treatment was in accordance with CPGs and 27,313 euros when it was not. In relation to relapse-free survival, compliance with CPGs strictly dominates non compliance, i.e. it is both less costly and more effective. Taking uncertainty into account, the probability that compliance with CPGs still strictly dominates was 75%. Conclusions Our findings should encourage physicians to increase their compliance with CPGs and healthcare administrators to invest in the implementation of CPGs in the management of

  7. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial.

    Science.gov (United States)

    van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke

    2016-04-02

    Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Offering CBT-I in an online format may increase access. Many studies have shown that online CBT for insomnia is effective. However, these studies have all been performed in general population samples recruited through media. This protocol article presents the design of a study aimed at establishing feasibility, effectiveness and cost-effectiveness of a guided online intervention (i-Sleep) for patients suffering from insomnia that seek help from their general practitioner as compared to care-as-usual. In a pragmatic randomized controlled trial, adult patients with insomnia disorder recruited through general practices are randomized to a 5-session guided online treatment, which is called "i-Sleep", or to care-as-usual. Patients in the care-as-usual condition will be offered i-Sleep 6 months after inclusion. An ancillary clinician, known as the psychological well-being practitioner who works in the GP practice (PWP; in Dutch: POH-GGZ), will offer online support after every session. Our aim is to recruit one hundred and sixty patients. Questionnaires, a sleep diary and wrist actigraphy will be administered at baseline, post intervention (at 8 weeks), and at 6 months and 12 months follow-up. Effectiveness will be established using insomnia severity as the main outcome. Cost-effectiveness and cost-utility (using costs per quality adjusted life year (QALY) as outcome) will be conducted from a societal perspective. Secondary measures are: sleep diary, daytime consequences, fatigue, work and social adjustment, anxiety, alcohol use, depression and quality of life. The results of this trial will help establish whether online CBT-I is (cost-) effective and feasible in general practice as compared

  8. Cost and time models for the evaluation of intermodal chains by using short sea shipping in the North Sea Region: the Rosyth-Zeebrugge route

    DEFF Research Database (Denmark)

    Lopez, Alba Martínez; Kronbak, Jacob; Jiang, Liping

    2015-01-01

    This paper is framed in the context of the EU Interreg IVB North Sea Region project Food Port. In line with this project, this paper aims to define mathematically cost and time models able to provide realistic information about the performances of road haulage and of intermodal chains using short...

  9. The ability of general circulation models to simulate tropical cyclones and their precursors over the North Atlantic main development region

    Energy Technology Data Exchange (ETDEWEB)

    Daloz, Anne Sophie; Chauvin, Fabrice [Groupe de Modelisation Grande Echelle et Climat, CNRM-GAME, Meteo-France, Toulouse Cedex 1 (France); Walsh, Kevin [University of Melbourne, School of Earth Sciences, Melbourne, VIC (Australia); Lavender, Sally; Abbs, Deborah [CSIRO Atmospheric and Marine Research, Aspendale, VIC (Australia); Roux, Frank [Universite de Toulouse and Centre National de la Recherche Scientifique, Laboratoire d' Aerologie, Toulouse (France)

    2012-10-15

    The ability of General Circulation Models (GCMs) to generate Tropical Cyclones (TCs) over the North Atlantic Main Development Region (MDR; 10-20 N, 20-80 W; Goldenberg and Shapiro in J Clim 9:1169-1187, 1996) is examined through a subset of ocean-atmosphere coupled simulations from the World Climate Research Programme (WCRP) Coupled Model Intercomparison Project phase 3 (CMIP3) multimodel data set and a high-resolution (0.5 ) Sea Surface Temperature (SST)-forced simulation from the Australian Conformal-Cubic Atmospheric Model GCM. The results are compared with National Center for Environmental Prediction (NCEP-2) and European Center for Medium Range Weather Forecasts Re-Analysis (ERA-40) reanalyses over a common period from 1980 to 1998. Important biases in the representation of the TC activity are encountered over the MDR. This study emphasizes the strong link in the GCMs between African Easterly Waves (AEWs) and TC activity in this region. However, the generation of AEWs is not a sufficient condition alone for the models to produce TCs. Precipitation over the Sahel, especially rainfall over the Fouta Djallon highlands (cf. Fig. 1), is playing a role in the generation of TCs over the MDR. The influence of large-scale fields such as SST, vertical wind shear and tropospheric humidity on TC genesis is also examined. The ability of TC genesis indices, such as the Genesis Potential Index and the Convective Yearly Genesis Potential, to represent TC activity over the MDR in simulations at low to high spatial resolutions is analysed. These indices are found to be a reasonable method for comparing cyclogenesis in different models, even though other factors such as AEW activity should also be considered. (orig.)

  10. Regional and sectoral marginal abatement cost curves for NOx incorporating controls, renewable electricity, energy efficiency and fuel switching

    Science.gov (United States)

    A marginal abatement cost curve (MACC) traces out the relationship between the quantity of pollution abated and the marginal cost of abating each additional unit. In the context of air quality management, MACCs typically are developed by sorting end-of-pipe controls by their resp...

  11. Assessment of healthcare measures, healthcare resource use, and cost of care among severe hemophilia A patients in Mumbai region of India.

    Science.gov (United States)

    Jadhav, U; Mukherjee, K

    2017-10-23

    In India, the low public health priority given to rare disorders such as hemophilia hinders their management and optimal care, leading to relatively poor health outcomes. This study aims to profile the multidimensional health status of patients with severe hemophilia A, and its association with the use of healthcare resources and the cost of care in Mumbai region of India. A cross-sectional, single-center study was conducted during January-May 2011, among 160 patients diagnosed with severe hemophilia A in Mumbai region of India. Their health status was documented using the Hemophilia Utilization Group Study's validated instrument of Functional Health Status Measure (FHS) and a single item of Self-care Measure. Of 160 patients, 55% (n = 88) scored on the lower side on the FHS, with an average score of 6.65 ± 2.85. The use of healthcare resources and cost of treatment were considerable for patients with a lower mean rank score on the FHS and a higher mean rank score on the self-care measure. The consumption of clotting factor concentrates (CFCs), number of visits to a health facility and incidence of inpatient episodes were significantly associated with a relatively low score on the FHS. Similarly, a higher cost of treatment, in terms of the cost of CFCs, direct cost, emergency room cost, and indirect cost, were significantly associated with a lower score on the FHS. The health status of patients with severe hemophilia A is compromised and has a significant impact on the use of healthcare resources and the cost of treatment.

  12. PRODUCTION COSTS AND PROFITABILITY OF ‘NIAGARA ROSADA’ TABLE GRAPE GROWN IN DIFFERENT REGIONS OF SÃO PAULO STATE

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    FERNANDO PEREZ CAPPELLO

    2017-10-01

    Full Text Available ABSTRACT Niagara Rosada is the main cultivar of table grapes produced in São Paulo state. Its production is concentrated mainly in the regions of Campinas, Itapetininga and Jales, where it is grown under different production systems. The aim of this study was to analyze the economic viability of cv. Niagara Rosada at main regions producers of São Paulo State. Therefore, case studies were made with grape growers for each region to assess the production cost and calculate profitability. In the Campinas region, for two cycles per year, the main crop and the second crop were evaluated, and the Total Cost (TC obtained was US$ 0.81/Kg, with US$ 0.23/Kg of Total Net Revenue (TNR. Considering only the main crop, the decrease of grape production increased the production cost and reduced profitability, the TC reached was US$ 0.93/Kg and TNR US$ 0.08/Kg. In the Itapetininga region, for two cycles per year, in main crop the TC was US$ 0.68/Kg and the TNR was US$ 0.32/Kg. Meanwhile, in the second crop, the lower productivity increased TC to US$ 1.05/Kg, but the higher price caused a TNR of US$ 0.38/Kg. In the Jales region, only one cycle per year, TC was increased to US$ 1.21/Kg, however, the high selling prices in the off-season in São Paulo State resulted in TNR of US$ 0.43/Kg. According to the results, the production of cv. Niagara Rosada in different regions of São Paulo State is profitable and has a positive return for family agriculture. Nevertheless, each region has its own characteristics in terms of production and commercialization of table grapes.

  13. High prevalence of missed opportunities for secondary fracture prevention in a regional general hospital setting in Singapore.

    Science.gov (United States)

    Gani, Linsey; Reddy, Saripalli K; Alsuwaigh, Rayan; Khoo, Joan; King, Thomas F J

    2017-12-01

    This study aims at assessing the gap in secondary fracture prevention at a regional general hospital setting in Singapore. Male patients have significantly lower rate of being investigated and treated for osteoporosis than their female counterparts. Vitamin D deficiency is prevalent in our population. Secondary fracture prevention services are not routine in Singapore; we seek to assess the treatment gap that exists in the lack of diagnosis and treatment of osteoporosis in fragility fracture patients. We performed a retrospective analysis of all admissions for fragility fractures between December 2013 and December 2014. Demographic data, rates of BMD performance, serum vitamin D investigation and calcium and vitamin D supplementation as well as antiresorptive initiation 1 year post admission were analysed. There were 125 fragility fractures in patients below 65 and 615 fractures in older patients. There was a slightly higher proportion of males in the younger population, whereas females predominated in the older population. Median vitamin D levels were low in both younger (19.1 μg/L) and older (22.0 μg/L) groups, but supplementation was lower in younger patients (4.8 versus 16.6%, p = 0.003). Rate of BMD performance was lower in younger patients (34.4 versus 64.6%, p Singapore. Male osteoporosis remains inadequately investigated and treated in both age groups.

  14. Pregabalin versus SSRIs and SNRIs in benzodiazepine-refractory outpatients with generalized anxiety disorder: a post hoc cost-effectiveness analysis in usual medical practice in Spain

    Directory of Open Access Journals (Sweden)

    De Salas-Cansado M

    2012-06-01

    Full Text Available Marina De Salas-Cansado,1 José M Olivares,2 Enrique Álvarez,3 Jose L Carrasco,4 Andoni Barrueta,5 Javier Rejas,51Trial Form Support Spain, Madrid; 2Department of Psychiatry, Hospital Meixoeiro, Complejo Hospitalario Universitario, Vigo; 3Department of Psychiatry, Hospital de la Santa Creu i San Pau, Barcelona; 4Department of Psychiatry, Hospital Clínico San Carlos, Madrid; 5Health Outcomes Research Department, Medical Unit, Pfizer Spain, Alcobendas, Madrid, SpainBackground: Generalized anxiety disorder (GAD is a prevalent health condition which seriously affects both patient quality of life and the National Health System. The aim of this research was to carry out a post hoc cost-effectiveness analysis of the effect of pregabalin versus selective serotonin reuptake inhibitors (SSRIs/serotonin norepinephrine reuptake inhibitors (SNRIs in treated benzodiazepine-refractory outpatients with GAD.Methods: This post hoc cost-effectiveness analysis used secondary data extracted from the 6-month cohort, prospective, noninterventional ADAN study, which was conducted to ascertain the cost of illness in GAD subjects diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Benzodiazepine-refractory subjects were those who claimed persistent symptoms of anxiety and showed a suboptimal response (Hamilton Anxiety Rating Scale ≥16 to benzodiazepines, alone or in combination, over 6 months. Patients could switch to pregabalin (as monotherapy or addon or to an SSRI or SNRI, alone or in combination. Effectiveness was expressed as quality-adjusted life years gained, and the perspective was that of the National Health System in the year 2008. A sensitivity analysis was performed using bootstrapping techniques (10,000 resamples were obtained in order to obtain a cost-effectiveness plane and a corresponding acceptability curve.Results: A total of 282 subjects (mean Hamilton Anxiety Rating Scale score 25.8 were

  15. Assessment of Health Care and Economic Costs Due to Episodes of Acute Pesticide Intoxication in Workers of Rural Areas of the Coquimbo Region, Chile.

    Science.gov (United States)

    Ramírez-Santana, Muriel; Iglesias-Guerrero, Juan; Castillo-Riquelme, Marianela; Scheepers, Paul T J

    2014-12-01

    The increase in agricultural activity that Chile experienced in the past 20 years resulted in a boost in the use of pesticides. Despite pesticides' productivity benefits, they caused health problems such as the increased frequency of episodes of acute poisoning, which constitutes a relevant problem in terms of occupational health. The Chilean authorities require several preventive measures at workplaces, which are not always implemented, increasing the risk of intoxications in farmers. So far in Chile, there are no studies concerning the public health care expenses associated with acute work-related pesticide intoxications. From the societal perspective, there are costs involved if the worker needs to take sick leave and families incur costs to take care of their sick members. This study aimed to determine the costs associated with health care services used by people who suffered from work-related acute pesticide poisoning, as well as the economic costs for the families of the workers involved, and finally the costs of these episodes for the employer/industrial sector. This study considered a 3-year period (January 2009 to December 2011). Three sources of data were reviewed: reported cases at the Regional Health Authority, for the profile of the intoxications; registers of patients attended in public hospitals, for data on costs of health care services; and public information of living conditions nationwide. The overall costs of a single case depend on the severity of intoxication, days of sick leave, and type of health care needed. Most cases (77%) would be ambulatory and would be assisted at an emergency room, with an average cost of US $330 per case. Those cases that might need hospitalization (23%) and, therefore, more days off work have an average cost of US $1158 per case. Taking into account the number of patients reported each year in the country, the cost per annum would be about US $185,000, but considering the underreporting of intoxications and

  16. Cost-effectiveness analysis of cervical cancer prevention based on a rapid human papillomavirus screening test in a high-risk region of China.

    Science.gov (United States)

    Levin, Carol E; Sellors, John; Shi, Ju-Fang; Ma, Li; Qiao, You-lin; Ortendahl, Jesse; O'Shea, Meredith K H; Goldie, Sue J

    2010-09-01

    This study assessed the cost-effectiveness of a new, rapid human papillomavirus (HPV)-DNA screening test for cervical cancer prevention in the high-risk region of Shanxi, China. Using micro-costing methods, we estimated the resources needed to implement preventive strategies using cervical cytology or HPV-DNA testing, including the Hybrid Capture 2 (hc2) test (QIAGEN Corp., Gaithersburg, MD) and the rapid HPV-DNA careHPV test (QIAGEN). Data were used in a previously published model and empirically calibrated to country-specific epidemiological data. Strategies differed by initial test, targeted age, frequency of screening, number of clinic visits required (1, 2 or 3) and service delivery setting (national, county and township levels). Outcomes included lifetime risk of cancer, years of life saved (YLS), lifetime costs and incremental cost-effectiveness ratios (cost per YLS). For all screening frequencies, the most efficient strategy used 2-visit rapid HPV-DNA testing at the county level, including screening and diagnostics in the first visit, and treatment in the second visit. Screening at ages 35, 40 and 45 reduced cancer risk by 50% among women compliant with all 3 screening rounds, and was US$ 150 per YLS, compared with this same strategy applied twice per lifetime. This would be considered very cost-effective evaluated against China's per-capita gross domestic product (US$ 1,702). By enhancing the linkage between screening and treatment through a reduced number of visits, rapid HPV-DNA testing 3 times per lifetime is more effective than traditional cytology, and is likely to be cost-effective in high-risk regions of China.

  17. A Socio-Ecological Approach to GIS Least-Cost Modelling for Regional Mining Infrastructure Planning: A Case Study from South-East Sulawesi, Indonesia

    Directory of Open Access Journals (Sweden)

    Alex M. Lechner

    2017-01-01

    Full Text Available Regional planning approaches to mining infrastructure aim to reduce the conflict associated with mining operations and existing land uses, such as urban areas and biodiversity conservation, as well as the cumulative impacts that occur offsite. In this paper, we describe a method for conducting Geographical Information System (GIS least-cost path and least-cost corridor analysis for linear mining infrastructure, such as roads. Least-cost path analysis identifies the optimal pathways between two locations as a function of the cost of traveling through different land use/cover types. In a case study from South-East Sulawesi, Indonesia, we identify potential linear networks for road infrastructure connecting mines, smelters, and ports. The method used interview data from government officials to characterise their orientation (perceived importance and positive/negative attitude toward the social and environmental factors associated with mining infrastructure. A cost-surface was constructed by integrating spatial layers representing the social and environmental factors to identify areas that should be avoided and areas that were compatible with linear infrastructure using the least-cost path analysis. We compared infrastructure scenario outputs from local and national government officials by the degree of spatial overlap and found broad spatial agreement for infrastructure corridors. We conclude by discussing this approach in relation to the wider social-ecological and mine planning literature and how quantitative approaches can reduce the conflict associated with infrastructure planning.

  18. Mental health care in Italy: organisational structure, routine clinical activity and costs of a community psychiatric service in Lombardy region.

    Science.gov (United States)

    Fattore, G; Percudani, M; Pugnoli, C; Contini, A; Beecham, J

    2000-01-01

    The Magenta Community Mental Health Centre (CMHC) is the public agency responsible for providing adult psychiatric care to about 85,000 adult residents. In 1995, it had 1,145 clients and incurred costs of Euro 1.9 millions. Average cost per patient and per adult resident were Euro 1,661 and Euro 22.2, respectively. These values mask large variation across diagnosis: while patients with schizophrenia and related disorders had an average cost of Euro 3,771, those with neurotic and related disorders had an average cost of Euro 439. Patients with schizophrenia and related disorders (28% of the patients) absorbed about 60% of total costs and made extensive use of several types of services (hospital, outpatient, domiciliary, social and rehabilitative care). Since integrating different types of services is the key element of Italian psychiatric care, the new fee-for-service system adopted by the NHS to fund providers does not appear appropriate, particularly for schizophrenic patients.

  19. Comparative review of three cost-effectiveness models for rotavirus vaccines in national immunization programs; a generic approach applied to various regions in the world

    Directory of Open Access Journals (Sweden)

    Tu Hong-Anh

    2011-07-01

    Full Text Available Abstract Background This study aims to critically review available cost-effectiveness models for rotavirus vaccination, compare their designs using a standardized approach and compare similarities and differences in cost-effectiveness outcomes using a uniform set of input parameters. Methods We identified various models used to estimate the cost-effectiveness of rotavirus vaccination. From these, results using a standardized dataset for four regions in the world could be obtained for three specific applications. Results Despite differences in the approaches and individual constituting elements including costs, QALYs Quality Adjusted Life Years and deaths, cost-effectiveness results of the models were quite similar. Differences between the models on the individual components of cost-effectiveness could be related to some specific features of the respective models. Sensitivity analysis revealed that cost-effectiveness of rotavirus vaccination is highly sensitive to vaccine prices, rotavirus-associated mortality and discount rates, in particular that for QALYs. Conclusions The comparative approach followed here is helpful in understanding the various models selected and will thus benefit (low-income countries in designing their own cost-effectiveness analyses using new or adapted existing models. Potential users of the models in low and middle income countries need to consider results from existing studies and reviews. There will be a need for contextualization including the use of country specific data inputs. However, given that the underlying biological and epidemiological mechanisms do not change between countries, users are likely to be able to adapt existing model designs rather than developing completely new approaches. Also, the communication established between the individual researchers involved in the three models is helpful in the further development of these individual models. Therefore, we recommend that this kind of comparative study

  20. A regional assessment of the cost and effectiveness of mitigation measures for reducing nutrient losses to water and greenhouse gas emissions to air from pastoral farms.

    Science.gov (United States)

    Vibart, Ronaldo; Vogeler, Iris; Dennis, Samuel; Kaye-Blake, William; Monaghan, Ross; Burggraaf, Vicki; Beautrais, Josef; Mackay, Alec

    2015-06-01

    Using a novel approach that links geospatial land resource information with individual farm-scale simulation, we conducted a regional assessment of nitrogen (N) and phosphorous (P) losses to water and greenhouse gas (GHG) emissions to air from the predominant mix of pastoral industries in Southland, New Zealand. An evaluation of the cost-effectiveness of several nutrient loss mitigation strategies applied at the farm-scale, set primarily for reducing N and P losses and grouped by capital cost and potential ease of adoption, followed an initial baseline assessment. Grouped nutrient loss mitigation strategies were applied on an additive basis on the assumption of full adoption, and were broadly identified as 'improved nutrient management' (M1), 'improved animal productivity' (M2), and 'restricted grazing' (M3). Estimated annual nitrate-N leaching losses occurring under representative baseline sheep and beef (cattle) farms, and representative baseline dairy farms for the region were 10 ± 2 and 32 ± 6 kg N/ha (mean ± standard deviation), respectively. Both sheep and beef and dairy farms were responsive to N leaching loss mitigation strategies in M1, at a low cost per kg N-loss mitigated. Only dairy farms were responsive to N leaching loss abatement from adopting M2, at no additional cost per kg N-loss mitigated. Dairy farms were also responsive to N leaching loss abatement from adopting M3, but this reduction came at a greater cost per kg N-loss mitigated. Only dairy farms were responsive to P-loss mitigation strategies, in particular by adopting M1. Only dairy farms were responsive to GHG abatement; greater abatement was achieved by the most intensified dairy farm system simulated. Overall, M1 provided for high levels of regional scale N- and P-loss abatement at a low cost per farm without affecting overall farm production, M2 provided additional N-loss abatement but only marginal P-loss abatement, whereas M3 provided the greatest N-loss abatement, but

  1. General Characteristics of Flora and Vegetation Formations of Eastern Anatolia Region and Its Environs (Türkiye

    Directory of Open Access Journals (Sweden)

    Münir ÖZTÜRK

    2015-07-01

    Full Text Available ABSTRACT: Eastern Anatolia and its environs are included in the Irano-Turanian phytogeographical region of Türkiye. The region abounds in highest mountain ranges (average 1900 m of the country some of which are of quarternary age and volcanic character. Many rivers of historical and international importance like Euphrates, Dicle, Murat, Karasu and Aras. Tigris, Aras and Çoruh flow through the region. It experiencens a typical continental climate. Soils are generally of alluvial, colluvial, chestnut-brown, regosal and basaltic types. The area embodies over 8 million ha of meadows and grasslands which is 41% of Türkiye's total pasturelands as such cattle raising is very high in this area. Forest vegetation is represented mainly by Pinus sylvestris, Quercus libani, Q. longipes, Q. brantii, Q. macranthera, Juniperus excelsa and Betula pendula. Most of these are highly degraded. Plant cover is rich in Irano - Turanian elements but we find Mediterranean and Euro-Siberian elements too to some extent, richest families being Asteraceae, Fabaceae and Poaceae, Lamiaceae, Caryophyllaceae and Apiaceae richest genera being Astragalus, Verbascum, Centaurea, Ranunculus, Alyssum, Vicia, Silene, Dianthus, Veronica and Trifolium. The number of endemics is very high, being around 950. And also the region has gene centers of genera Astragalus, Gypsophila, Cousinia, Acanthophyllum etc. The some typical associations one comes across in this area are; Triseto-Pinetum sylvestris, Trifolio-Pinetum sylvestris, Ballato-Rhamnetum pallasii, Caragano-Minuartietum lineatea, Hippophaetum rhamnoidis, Typho-Juncetum inflecii, Hordeetum violaceumii, Deschampsio-Ranunculetum brachylobus, Hordeeto-Ranunculetum comosae and Polygon-Primuletum auriculatae. Dominantly vegetation of the region is steppe. The are a lot of natural plant taxa using local people. Key Words: Eastern Anatolia, Flora, Vegetation, Biodiversity, Geobotany, Endemism, Türkiye. Doğu Anadolu Bölgesi ve

  2. Matching demand with supply at low cost in 139 countries among 20 world regions with 100% intermittent wind, water, and sunlight (WWS) for all purposes

    DEFF Research Database (Denmark)

    Jacobson, Mark Z.; Delucchi, Mark A.; Cameron, Mary A.

    2018-01-01

    Matching electricity, heat, and cold demand with supply at low cost is the greatest concern facing countries seeking to provide their all-purpose energy with 100% clean, renewable wind, water, and sunlight (WWS). Implementing WWS worldwide could eliminate 4–7 million annual air pollution deaths......, first slow then reverse global warming, and provide energy sustainably. This study derives zero-load-loss technical solutions to matching demand with 100% WWS supply; heat, cold, and electricity storage; hydrogen production; assumed all-distance transmission; and demand response for 20 world regions...... are similar, WWS requires ∼42.5% less energy in a base case and ∼57.9% less in a heat-pump case so may reduce capital and consumer costs significantly. Further, WWS social (energy + health + climate) costs per unit energy are one-fourth BAU's. By reducing water vapor, the wind turbines proposed may rapidly...

  3. Socioeconomic disadvantage and its implications for population health planning of obesity and overweight, using cross-sectional data from general practices from a regional catchment in Australia

    OpenAIRE

    Ghosh, Abhijeet; Charlton, Karen E; Batterham, Marijka J

    2016-01-01

    Objectives To identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity. Design Cross-sectional secondary analysis of data. Setting Primary healthcare?17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW). Participants A subset (n=36?674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118?794) that included information on disease status of all adult patients who had hei...

  4. Pavement, bridge, and safety cost evaluation tool for overweight truck corridors serving coastal port regions and border ports of entry

    Science.gov (United States)

    2017-08-01

    To address the need for a rational but fast method to determine costs and a proposed permit fee, the research team developed the Stage 1 Expedient Analysis Method. The method was used to evaluate potential oversize/overweight (OS/OW) freight corridor...

  5. Costs of ulcerative colitis from a societal perspective in a regional health care area in Spain: A database study.

    Science.gov (United States)

    Aldeguer, Xavier; Sicras-Mainar, Antoni

    2016-01-01

    To estimate the management of UC associated costs from the societal perspective in Spain. Observational, longitudinal study with retrospective data collection based on reviews of outpatient health records. Socio-demographic, clinical and sick leave information was gathered. Patients diagnosed of UC between 2002 and 2012, older than 18 years, followed-up by a minimum of 12 months post diagnosis, with at least two clinical and use of resources data recorded, were included. 285 UC patients [51.2% men; 44.5 (SD: 15.6) years old; 88.4% without family history of UC; 39.3% proctitis; 5.6 (2.5) years disease follow-up] participated. More than half (65.6%) were active workers, 75.9% were on sick leave for reasons different from UC [mean 0.66 (0.70) times per year] during (mean) 28.43 (34.45) days. Only 64 patients were on UC-related sick-leaves, lasting (mean) 26.17 (37.43) days. Absenteeism due to medical visits caused loss of 29.55 (21.38) working hours per year. Mean direct and indirect annual cost per UC patient were €1754.10 (95%CI: 1473.37-2034.83) and €399.32 (282.31-422.69), respectively. Absenteeism was estimated at €88.21(32.72-50.06) per patient per year, in which sick-leaves were the main component of indirect costs (88.2%). Age, UC family history, diarrhea at diagnosis, blood and blood-forming organs diseases and psychological disorders were the main predictors of indirect costs. UC is a costly disease for the society and the Spanish National Healthcare System. Indirect costs imply a major burden by affecting the most productive years of patients. Further research is needed considering all components of productivity loss, including presenteeism-associated costs. Copyright © 2015 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

  6. A cost-minimization analysis of root canal treatment before and after education in nickel-titanium rotary technique in general practice.

    Science.gov (United States)

    Koch, M; Tegelberg, A; Eckerlund, I; Axelsson, S

    2012-07-01

    To compare root canal treatments performed before and after education in a nickel-titanium rotary technique (NiTiR) with respect to costs for instrumentation and number of instrumentation sessions in a County Public Dental Service in Sweden.   Following education, 77% of the general dental practitioners adopted completely the NiTiR. The randomly selected sample comprised 850 root canal treatments: 425 performed after the education, mainly using the NiTiR-technique (group A) and 425 performed before, using mainly stainless steel hand instrumentation (SSI) (group B). The number of instrumentation sessions in root canal treatments in group A and B was calculated. A CMA was undertaken on the assumption that treatment outcome was identical in group A and B. Direct costs associated with SSI and NiTiR were estimated and compared. Investment costs required for implementation of NiTiR were calculated, but not included in the CMA. Instrumentation sessions were counted in 418 (98%) root canal treatments performed in group A and 419 (99%) in group B. The number of instrumentation sessions in group A was significantly lower; 2.38, compared with 2.82 in group B (P session was saved. Root canal treatments in teeth with one canal, and three or more canals, were completed in significantly fewer instrumentation sessions after the education (P sessions were SEK 2587 (USD 411) for group A and SEK 2851 (USD 453) for group B, for teeth with one canal, and SEK 2946 (USD 468) for group A and SEK 3510 (USD 558) for group B, for teeth with three or more canals (year 2011). Root canal treatments of teeth with two canals showed no significant difference with respect to number of instrumentation sessions and costs. Significantly fewer instrumentation sessions were required in group A, and root canal instrumentation therefore costs less than in group B. On the assumption that treatment outcome is identical in group A and B, root canal instrumentation performed after the education was more

  7. Cost/benefit analysis of biomass energy supply options for rural smallholders in the semi-arid eastern part of Shinyanga Region in Tanzania

    Energy Technology Data Exchange (ETDEWEB)

    Wiskerke, W.T.; Dornburg, V.; Faaij, A.P.C. [Department of Science, Technology and Society, Utrecht University, Heidelberglaan 2, 3584 CS, Utrecht (Netherlands); Rubanza, C.D.K. [Tanzania Forestry Research Institute (TAFORI)/National Forest Resource Management and Agroforestry Centre (NACRAF), P.O. Box 1257, Shinyanga (Tanzania); Malimbwi, R.E. [Faculty of Forestry and Natural Resources, Sokoine University, P.O. Box 3010, Morogoro (Tanzania)

    2010-01-15

    This study analyzes the economic feasibility of sustainable smallholder bio-energy production under semi-arid conditions. The eastern part of Shinyanga region in Tanzania was chosen as a case study area. Three different sustainable biomass energy supply systems were compared by means of cost/benefit analysis: a small-scale forestation project for carbon sequestration, a short rotation woodlot and a Jatropha plantation, thereby using the produced Jatropha oil as a substitute for fuelwood or diesel. Rotational woodlots are most profitable with a Net Present Value of up to US${sub 2007} 1165/ha, a return on labour of up to US${sub 2007} 6.69/man-day and a fuelwood production cost of US${sub 2007} 0.53/GJ, compared to a local market price of US${sub 2007} 1.95/GJ. With a production cost of US${sub 2007} 19.60/GJ, Jatropha oil is too expensive to be used as an alternative for fuelwood. Instead it can be utilized economically as a diesel substitute, at an observed diesel cost of US${sub 2007} 1.49/l. The mean annual biomass increment (MAI) in semi-arid East Shinyanga is too low to collect sufficient benefits from trading forestation carbon credits under the Clean Development Mechanism (CDM) to cover the costs of forestation and forest management. (author)

  8. Report: Implementation Plan With Cost Sharing Methodology Needed for Region 8 Senior Environmental Employee Work on Lead Risk Reduction

    Science.gov (United States)

    Report #13-P-0430, September 24, 2013. The two Region 8 program offices that jointly implement the Lead Renovation, Repair and Painting Program do not have methodology or agreement for sharing SEE funding, which has led to confusion.

  9. Access to diagnostic tests and essential medicines for cardiovascular diseases and diabetes care: cost, availability and affordability in the West Region of Cameroon.

    Directory of Open Access Journals (Sweden)

    Ahmadou M Jingi

    Full Text Available To assess the availability and affordability of medicines and routine tests for cardiovascular disease (CVD and diabetes in the West region of Cameroon, a low-income setting.A survey was conducted on the availability and cost of twelve routine tests and twenty medicines for CVD and diabetes in eight health districts (four urban and four rural covering over 60% of the population of the region (1.8 million. We analyzed the percentage of tests and medicines available, the median price against the international reference price (median price ratio for the medicines, and affordability in terms of the number of days' wages it would cost the lowest-paid unskilled government worker for initial investigation tests and procurement for one month of treatment.The availability of tests varied between 10% for the ECG to 100% for the fasting blood sugar. The average cost for the initial investigation using the minimum tests cost 29.76 days' wages. The availability of medicines varied from 36.4% to 59.1% in urban and from 9.1% to 50% in rural settings. Only metformin and benzathine-benzylpenicilline had a median price ratio of ≤ 1.5, with statins being largely unaffordable (at least 30.51 days' wages. One month of combination treatment for coronary heart disease costs at least 40.87 days' wages.The investigation and management of patients with medium-to-high cardiovascular risk remains largely unavailable and unaffordable in this setting. An effective non-communicable disease program should lay emphasis on primary prevention, and improve affordable access to essential medicines in public outlets.

  10. Assessing the economic impact of North China’s water scarcity mitigation strategy : a multi - region, water - extended computable general equilibrium analysis

    NARCIS (Netherlands)

    Qin, Changbo; Qin, C.; Su, Zhongbo; Bressers, Johannes T.A.; Jia, Y.; Wang, H.

    2013-01-01

    This paper describes a multi-region computable general equilibrium model for analyzing the effectiveness of measures and policies for mitigating North China’s water scarcity with respect to three different groups of scenarios. The findings suggest that a reduction in groundwater use would negatively

  11. Financial Management: Processing General Services Administration Rent Bills for DoD Customers in the National Capital Region

    National Research Council Canada - National Science Library

    Granetto, Paul

    2003-01-01

    .... The Washington Headquarters Services (WHS) is responsible for the oversight and management of administrative space occupied by DoD agencies and Military departments in the National Capital Region...

  12. Comparative effectiveness and costs of generic and brand-name gabapentin and venlafaxine in patients with neuropathic pain or generalized anxiety disorder in Spain

    Directory of Open Access Journals (Sweden)

    Sicras-Mainar A

    2015-06-01

    Full Text Available Antoni Sicras-Mainar,1 Javier Rejas-Gutiérrez,2 Ruth Navarro-Artieda3 1Planning Directorate, Badalona Serveis Assistencials SA, Badalona, Barcelona, Spain; 2Department of Health Economics and Outcomes Research, Pfizer SLU, Alcobendas, Madrid, Spain; 3Medical Documentation, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain Objective: To explore adherence/persistence with generic gabapentin/venlafaxine versus brand-name gabapentin/venlafaxine (Neurontin®/Vandral® in peripheral neuropathic pain (pNP or generalized anxiety disorder (GAD, respectively, and whether it is translated into different costs and patient outcomes in routine medical practice. Methods: A retrospective, new-user cohort study was designed. Electronic medical records (EMR of patients included in the health plan of Badalona Serveis Assistencials SA, Barcelona, Spain were exhaustively extracted for analysis. Participants were beneficiaries aged 18+ years, followed between 2008 and 2012, with a pNP/GAD International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM code, who initiated treatment with generic or brand-name gabapentin or venlafaxine. Assessments included 1-year treatment persistence and adherence (medication possession ratio, health care costs, and reduction in severity of pain and anxiety symptoms. Results: A total of 2,210 EMR were analyzed; 1,369 on gabapentin (brand 400; generic 969 and 841 on venlafaxine (brand 370 and generic 471. Brand-name gabapentin and venlafaxine were both significantly associated with longer persistence than generic: 7.3 versus 6.3 months, P<0.001; and 8.8 versus 8.1 months, P<0.05, respectively. Brand-name was associated with higher adherence: 86.5% versus 81.3%, P<0.001; and 82.1% versus 79.0%, P<0.05, respectively. Adjusted average costs were higher with generic compared with brand: €1,277 versus €1,057 (difference of €220 per patient; P<0.001 for gabapentin; and €1,110 versus €928

  13. Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan.

    Science.gov (United States)

    Chen, Chien-Min; Ke, Yen-Liang

    2016-02-01

    One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs. The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design. All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs. The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5 ± 3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI) = 138.5-2012.9], dysphagia [coefficient (B), 1025.8; 95% CI = 193.9-1857.8], number of surgeries [coefficient (B), 796.4; 95% CI = 316.0-1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI = 1339.5-3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI = 221.6-2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI = 31.2-98.7] (R(2) = 0.387). Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.

  14. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-10-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

  15. Comparative effectiveness and costs of generic and brand-name gabapentin and venlafaxine in patients with neuropathic pain or generalized anxiety disorder in Spain.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Rejas-Gutiérrez, Javier; Navarro-Artieda, Ruth

    2015-01-01

    To explore adherence/persistence with generic gabapentin/venlafaxine versus brand-name gabapentin/venlafaxine (Neurontin(®)/Vandral(®)) in peripheral neuropathic pain (pNP) or generalized anxiety disorder (GAD), respectively, and whether it is translated into different costs and patient outcomes in routine medical practice. A retrospective, new-user cohort study was designed. Electronic medical records (EMR) of patients included in the health plan of Badalona Serveis Assistencials SA, Barcelona, Spain were exhaustively extracted for analysis. Participants were beneficiaries aged 18+ years, followed between 2008 and 2012, with a pNP/GAD International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code, who initiated treatment with generic or brand-name gabapentin or venlafaxine. Assessments included 1-year treatment persistence and adherence (medication possession ratio), health care costs, and reduction in severity of pain and anxiety symptoms. A total of 2,210 EMR were analyzed; 1,369 on gabapentin (brand 400; generic 969) and 841 on venlafaxine (brand 370 and generic 471). Brand-name gabapentin and venlafaxine were both significantly associated with longer persistence than generic: 7.3 versus 6.3 months, PBrand-name was associated with higher adherence: 86.5% versus 81.3%, Pbrand: €1,277 versus €1,057 (difference of €220 per patient; Pbrand-name was associated with higher reduction in pain (7.8%; Pbrand-name gabapentin or venlafaxine were more likely to adhere and persist on treatment of pNP or GAD, have lower health care costs, and show further reduction of pain and anxiety symptoms than with generic drugs in routine medical practice.

  16. Cost-Effective Recruitment need for 24x7 Paediatricians in the State General Hospitals in Relation to the Reduction of Infant Mortality.

    Science.gov (United States)

    Chatterjee, Ranjana; Chatterjee, Sukanta

    2016-10-01

    According to World Health Organisation (WHO), improvement of hospital based care can have an impact of upto 30% in reducing Infant Mortality Rate (IMR), whereas, strengthening universal outreach and family-community based care is known to have a greater impact. The study intends to assess how far gaps in the public health facilities contribute towards infant mortality, as 2/3 rd of infant mortality is due to suboptimum care seeking and weak health system. To identify cost-effectiveness of employment of additional paediatric manpower to provide round the clock skilled service to reduce IMR in the present state health facilities at the district general hospitals. A cross-sectional observational study was conducted in a tertiary teaching hospital and district hospitals of 2 districts (Hooghly and Howrah in West Bengal). Factors affecting infant mortality and shift wise analysis of proportion of infant deaths were analysed in both tertiary and district level hospitals. Information was gathered in a predesigned proforma for one year period by verifying hospital records and by personal interview with service personnel in the health establishment. SPSS software version 17 (Chicago, IL) was used. The p-value was calculated by Fischer exact t-test. Available hospital beds per 1000 population were 1.1. Percentage of paediatric beds available in comparison to total hospital bed was disproportionately lower (10%). Dearth of skilled medical care provider at odd hours in district hospitals resulted in significantly greater infant death (p based infant mortality and it is cost-effective.

  17. Normal values of regional left ventricular myocardial thickness, mass and distribution-assessed by 320-detector computed tomography angiography in the Copenhagen General Population Study

    DEFF Research Database (Denmark)

    Hindsø, Louise; Fuchs, Andreas; Kühl, Jørgen Tobias

    2017-01-01

    regional normal reference values of the left ventricle. The aim of this study was to derive reference values of regional LV myocardial thickness (LVMT) and mass (LVMM) from a healthy study group of the general population using cardiac computed tomography angiography (CCTA). We wanted to introduce LV...... myocardial distribution (LVMD) as a measure of regional variation of the LVMT. Moreover, we wanted to determine whether these parameters varied between men and women. We studied 568 (181 men; 32%) adults, free of cardiovascular disease and risk factors, who underwent 320-detector CCTA. Mean age was 55 (range...... 40-84) years. Regional LVMT and LVMM were measured, according to the American Heart Association's 17 segment model, using semi-automatic software. Mean LVMT were 6.6 mm for men and 5.4 mm for women (p normal LV was thickest in the basal septum (segment 3; men = 8.3 mm; women = 7.2 mm...

  18. Effects of different types of anaesthesia (regional vs general) on serum IL-6, IL-8 and M-CSF levels in surgical patients

    International Nuclear Information System (INIS)

    Xiao Jiawang

    2009-01-01

    Objective: To study the effect of anesthesia(regional vs general) on serum IL-6, IL-8 and M-CSF levels in surgical patients. Methods: Serum IL-6, IL-8 and M-CSF levels were determined with RIA 3 times in 34 patients operated under ragional anesthesia and 34 patients operted under general anesthesia (both for benign gastral ulcer). The levels were measured before induction of anesthesia, at beginning of operation and 1 hr later. Results: In patients under regional anesthesia, the IL-6, IL-8 and M-CSF levels increased significantly at the beginning of operation and 1 hr later. Though dropped remained significantly higher than the levels before induction (P<0.05); No significant change of the levels were obsorved in patients under general anesthesia through the operation, and the levels were as a whole significantly lower than the levels under regional anesthesia (P<0.05). Conclusion: General anesthesia (combined intravenous and inhalation) could abolish increases of serum IL-6, IL-8 and M-CSF levels during operation must be of clinical values. (authors)

  19. Influence of age on the prognostic value of mid-regional pro-adrenomedullin in the general population

    NARCIS (Netherlands)

    Brouwers, Frank P.; de Boer, Rudolf A.; van der Harst, Pim; Struck, Joachim; de Jong, Paul E.; de Zeeuw, Dick; Gans, Rijk O.; Gansevoort, Ron T.; Hillege, Hans L.; van Gilst, Wiek H.; Bakker, Stephan J.

    Objective Experimental studies have shown that adrenomedullin (ADM) has an important role in circulatory homeostasis. Mid-regional pro-ADM (MR-proADM) is a stable form of ADM. Observational studies found an important association with age, body mass index and kidney function. The aim of this study

  20. Solutions for Determining the Significance Region Using the Johnson-Neyman Type Procedure in Generalized Linear (Mixed) Models

    Science.gov (United States)

    Lazar, Ann A.; Zerbe, Gary O.

    2011-01-01

    Researchers often compare the relationship between an outcome and covariate for two or more groups by evaluating whether the fitted regression curves differ significantly. When they do, researchers need to determine the "significance region," or the values of the covariate where the curves significantly differ. In analysis of covariance (ANCOVA),…

  1. [Study on HIV-1 subtype among elderly male clients and female sex workers of low-cost venues in Guangxi Zhuang Autonomous Region, China].

    Science.gov (United States)

    Deng, Y Q; Li, J J; Fang, N Y; Wang, B; Wang, J W; Liang, S S; Shen, Z Y; Lan, G H; Zhang, H M; Wu, X H; Lu, H X; Ge, X M

    2017-03-10

    Objective: To understand HIV-1 subtype characteristics and transmission clusters in elderly male clients and female sex workers (FSWs) of low-cost commercial sex venues in Guangxi Zhuang Autonomous Region, China. Methods: A cross sectional survey was conducted in FSWs and elderly male clients (≥50 years) of low-cost commercial sex venues in 4 cities and 9 counties in Guangxi Zhuang Autonomous Region by convenient sampling in 2012. The blood sample was collected from each case for HIV-1 antibody detection. The pol gene fragments were amplified and sequenced from viral RNA template extracted from plasma samples. The phylogenetic tree was constructed and the subtypes were identified. Results: A total of 4 048 elderly male clients and 784 FSWs were surveyed, and 116 HIV-1 infections were detected, the positive rate was 2.5% (103/4 048) in the clients and 1.7% (13/784) in FSWs. The gene amplification and sequencing of HIV-1 detected in 84 blood samples indicated that 53 pol gene sequences were successfully determined (48 blood samples from elderly male clients and 5 blood samples from FSWs). Among 53 pol sequences, 48(90.6% ), 4(7.5% ), and 1(1.9% ) sequences were identified as CRF01_AE, CRF08_BC, and CRF07_BC, respectively. Two transmission clusters were identified among CRF01_AE, including 4 sub-clusters. One transmission cluster was identified among CRF08_BC. The transmission cluster or sub-cluster were from the infected individuals at same low-cost commercial sex venue, or different low-cost commercial sex venues in the same town, or same place, or adjacent villages and towns. Conclusions: CRF01_AE was the predominant HIV-1 subtype among elderly male clients and FSWs of low-cost commercial sex venues in Guangxi Zhuang Autonomous Region, circulating in same venue or adjacent villages and towns. The HIV-1 positive male clients and FSWs might play an important role in the spread of the strains.

  2. Thermal perceptions, general adaptation methods and occupant's idea about the trade-off between thermal comfort and energy saving in hot-humid regions

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ruey-Lung [Department of Occupational Safety and Health, China Medical University, 91 Huseh-Shin Road, Taichung 404 (China); Cheng, Ming-Jen [Department of Architecture, Feng Chia University, 100 Wen-Hwa Road, Seatwen, Taichung 407 (China); Lin, Tzu-Ping [Department of Leisure Planning, National Formosa University, 64 Wen-Hua Road, Huwei, Yunlin 632 (China); Ho, Ming-Chin [Architecture and Building Research Institute, Ministry of the Interior, 13F, No. 200, Sec. 3, Bei-sin Road, Sindian City, Taipei County 231 (China)

    2009-06-15

    A field study conducted in workplaces and residences in Taiwan is carried out to clarify two questions in detail: (1) do people in the tropical climate regions demonstrate a correlation between thermal sensation and thermal dissatisfaction the same as the PMV-PPD formula in the ISO 7730; and (2) does the difference in opportunities to choose from a variety of methods to achieve thermal comfort affects thermal perceptions of occupants? A new predicted formula of percentage of dissatisfied (PD) relating to mean thermal sensation votes (TSVs) is proposed for hot and humid regions. Besides an increase in minimum rate of dissatisfied from 5% to 9%, a shift of the TSV with minimum PD to the cool side of sensation scale is suggested by the new proposed formula. It also reveals that the limits of TSV corresponding to 80% acceptability for hot and humid regions are -1.45 and +0.65 rather than -0.85 and +0.85 suggested by ISO 7730. It is revealed in the findings that the effectiveness, availability and cost of a thermal adaptation method can affect the interviewees' thermal adaptation behaviour. According to the discussion of interviewees' idea about the trade-off between thermal comfort and energy saving, it is found that an energy-saving approach at the cost of sacrificing occupant's thermal comfort is difficult to set into action, but those ensure the occupant's comfort are more acceptable and can be easily popularized. (author)

  3. Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2007-02-01

    Full Text Available Abstract Background Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated. Methods/Design CC: DIM (Collaborative Care: Depression Initiative in the Medical setting is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36. Discussion Earlier research has indicated that depressive disorder is

  4. Generalized stability regions of current control for LCL-filtered grid-connected converters without passive or active damping

    DEFF Research Database (Denmark)

    Tang, Yi; Yoon, Changwoo; Zhu, Rongwu

    2015-01-01

    This paper investigates the stability regions of current control for LCL-filtered grid-connected converters, where no active or passive damping is required to stabilize the closed-loop control system. It is already identified in the literature that if the LCL resonance frequency is placed within 1....../6 to 1/2 of the system sampling frequency, the grid current control can be directly used without damping. If the resonance frequency is smaller than 1/6 of the sampling frequency, the converter current control should then be adopted. This paper further extends the analysis to the cases where...... the resonance frequency could be larger than 1/2 of the sampling frequency, and derives the complete stability regions for both grid and converter current control. Interestingly, it is found that for any given LCL-filter design, there will always be one stable current control design without any damping, which...

  5. Value of systematic intervention for chronic obstructive pulmonary disease in a regional Japanese city based on case detection rate and medical cost

    Directory of Open Access Journals (Sweden)

    Tawara Y

    2015-08-01

    Full Text Available Yuichi Tawara,1 Hideaki Senjyu,1 Kenichiro Tanaka,1 Takako Tanaka,1 Masaharu Asai,1 Ryo Kozu,2 Mitsuru Tabusadani,3 Sumihisa Honda,1 Terumitsu Sawai1 1Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; 2Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan; 3Center for Industry, University and Government Cooperation, Nagasaki University, Nagasaki, Japan Objective: We established a COPD taskforce for early detection, diagnosis, treatment, and intervention. We implemented a pilot intervention with a prospective and longitudinal design in a regional city. This study evaluates the usefulness of the COPD taskforce and intervention based on COPD case detection rate and per capita medical costs.Method: We distributed a questionnaire to all 8,878 inhabitants aged 50–89 years, resident in Matsuura, Nagasaki Prefecture in 2006. Potentially COPD-positive persons received a pulmonary function test and diagnosis. We implemented ongoing detection, examination, education, and treatment interventions, performed follow-up examinations or respiratory lessons yearly, and supported the health maintenance of each patient. We compared COPD medical costs in Matsuura and in the rest of Nagasaki Prefecture using data from 2004 to 2013 recorded by the association of Nagasaki National Health Insurance Organization, assessing 10-year means and annual change.Results: As of 2014, 256 people have received a definitive diagnosis of COPD; representing 31% of the estimated total number of COPD patients. Of the cases detected, 87.5% were mild or moderate in severity. COPD medical costs per patient in Matsuura were significantly lower than the rest of Nagasaki Prefecture, as was rate of increase in cost over time.Conclusion: The COPD program in Matsuura enabled early detection and treatment of COPD patients and helped to lower the associated burden of medical costs. The

  6. Heroes of Civilization. The Amazon Region as Agricultural Export Cosmopolis in the Work of General Rafael Reyes

    Directory of Open Access Journals (Sweden)

    Felipe Martínez Pinzón

    2013-07-01

    the isthmus led the Colombian elites to rethink other border spaces. The article analyzes the discourse of appropriation of the Amazon territory set forth by President, General, and entrepreneur Rafael Reyes (1849-1921 in speeches lectures, travel diaries, and autobiographical memoirs. On the basis of those materials, the article argues that instead of nationalizing the Amazonian territory, Reyes suggesting incorporating it into the dynamics of global capitalism through the contradictory proposal of an “agricultural export cosmopolis” aimed at exploiting the region’s wealth. The contradictions of a segregationist cosmopolis, as a narrative of globalization in the early 20th century, also led General Reyes to represent the entrepreneurs of the agricultural frontier as “heroes of civilization”, a phrase that betrays the anachronism and irrationalism inherent in the allegedly indestructible rational discourse of civilization in the tropics.

  7. Origin of surface and columnar Indian Ocean Experiment (INDOEX) aerosols using source- and region-tagged emissions transport in a general circulation model

    Science.gov (United States)

    Verma, S.; Venkataraman, C.; Boucher, O.

    2008-12-01

    We study the relative influence of aerosols emitted from different sectors and geographical regions on aerosol loading in south Asia. Sectors contributing aerosol emissions include biofuel and fossil fuel combustion, open biomass burning, and natural sources. Geographical regions include India (the Indo-Gangetic plain, central India, south India, and northwest India), southeast Asia, east Asia, Africa-west Asia, and the rest of the world. Simulations of the Indian Ocean Experiment (INDOEX), from January to March 1999, are made in the general circulation model of Laboratoire de Météorologie Dynamique (LMD-ZT GCM) with emissions tagged by sector and geographical region. Anthropogenic emissions dominate (54-88%) the predicted aerosol optical depth (AOD) over all the receptor regions. Among the anthropogenic sectors, fossil fuel combustion has the largest overall influence on aerosol loading, primarily sulfate, with emissions from India (50-80%) and rest of the world significantly influencing surface concentrations and AOD. Biofuel combustion has a significant influence on both the surface and columnar black carbon (BC) in particular over the Indian subcontinent and Bay of Bengal with emissions largely from the Indian region (60-80%). Open biomass burning emissions influence organic matter (OM) significantly, and arise largely from Africa-west Asia. The emissions from Africa-west Asia affect the carbonaceous aerosols AOD in all receptor regions, with their largest influence (AOD-BC: 60%; and AOD-OM: 70%) over the Arabian Sea. Among Indian regions, the Indo-Gangetic Plain is the largest contributor to anthropogenic surface mass concentrations and AOD over the Bay of Bengal and India. Dust aerosols are contributed mainly through the long-range transport from Africa-west Asia over the receptor regions. Overall, the model estimates significant intercontinental incursion of aerosol, for example, BC, OM, and dust from Africa-west Asia and sulfate from distant regions (rest

  8. Testing the generality of the zoom-lens model: Evidence for visual-pathway specific effects of attended-region size on perception.

    Science.gov (United States)

    Goodhew, Stephanie C; Lawrence, Rebecca K; Edwards, Mark

    2017-05-01

    There are volumes of information available to process in visual scenes. Visual spatial attention is a critically important selection mechanism that prevents these volumes from overwhelming our visual system's limited-capacity processing resources. We were interested in understanding the effect of the size of the attended area on visual perception. The prevailing model of attended-region size across cognition, perception, and neuroscience is the zoom-lens model. This model stipulates that the magnitude of perceptual processing enhancement is inversely related to the size of the attended region, such that a narrow attended-region facilitates greater perceptual enhancement than a wider region. Yet visual processing is subserved by two major visual pathways (magnocellular and parvocellular) that operate with a degree of independence in early visual processing and encode contrasting visual information. Historically, testing of the zoom-lens has used measures of spatial acuity ideally suited to parvocellular processing. This, therefore, raises questions about the generality of the zoom-lens model to different aspects of visual perception. We found that while a narrow attended-region facilitated spatial acuity and the perception of high spatial frequency targets, it had no impact on either temporal acuity or the perception of low spatial frequency targets. This pattern also held up when targets were not presented centrally. This supports the notion that visual attended-region size has dissociable effects on magnocellular versus parvocellular mediated visual processing.

  9. Water, Air Emissions, and Cost Impacts of Air-Cooled Microturbines for Combined Cooling, Heating, and Power Systems: A Case Study in the Atlanta Region

    Directory of Open Access Journals (Sweden)

    Jean-Ann James

    2016-12-01

    Full Text Available The increasing pace of urbanization means that cities and global organizations are looking for ways to increase energy efficiency and reduce emissions. Combined cooling, heating, and power (CCHP systems have the potential to improve the energy generation efficiency of a city or urban region by providing energy for heating, cooling, and electricity simultaneously. The purpose of this study is to estimate the water consumption for energy generation use, carbon dioxide (CO2 and NOx emissions, and economic impact of implementing CCHP systems for five generic building types within the Atlanta metropolitan region, under various operational scenarios following the building thermal (heating and cooling demands. Operating the CCHP system to follow the hourly thermal demand reduces CO2 emissions for most building types both with and without net metering. The system can be economically beneficial for all building types depending on the price of natural gas, the implementation of net metering, and the cost structure assumed for the CCHP system. The greatest reduction in water consumption for energy production and NOx emissions occurs when there is net metering and when the system is operated to meet the maximum yearly thermal demand, although this scenario also results in an increase in greenhouse gas emissions and, in some cases, cost. CCHP systems are more economical for medium office, large office, and multifamily residential buildings.

  10. Factors associated with non-attendance in a general practice super clinic population in regional Australia: A retrospective cohort study.

    Science.gov (United States)

    Nancarrow, Susan; Bradbury, Joanne; Avila, Catherine

    2014-01-01

    Non-attendance at medical appointments is associated with increased patient morbidity and is a significant drain on health service resources. Australian studies have focused on secondary healthcare settings, screening, and interventions to reduce non-attendance. To explore factors associated with non-attendance in a regional primary care setting. A retrospective cohort of all patients with a scheduled appointment between October 2011 and October 2013 at a regional, primary care clinic providing medical and allied health services in a region of New South Wales (NSW) serving a large Aboriginal population (10.7 per cent). Using multivariate logistic regression, non-attendance was regressed on a range of covariates, including number of appointments per person, gender and ethnicity, and day of the week. The overall proportion of missed appointments was 7.6 per cent. Risk factors for non-attendance were day of the week [Mondays (8.1 per cent), Fridays (8.0 per cent), and Thursdays (7.9 per cent), (χ2(4)= 20.208, pattend (FTA) (95% CI: 11-28%)]; Aboriginality (OR=4.022, 95% CI: 3.263, 4.956), and female gender (OR=1.077; 95% CI 1.024, 1.132). There was a trend toward an interaction between gender and Aboriginality, with Aboriginal females being the group most likely to miss appointments (OR=1.272, 95% CI: 0.949, 1.705). This is the largest study of non-attendance in an Australian primary healthcare setting. While not a typical setting, the study had the advantage of a large, mixed population. The suggested high rates of non-attendance by Aboriginal females have potentially important policy implications.

  11. A general method, a la Transport, for evaluation of the perturbing effects of solenoidal inserts in storage ring interaction regions

    International Nuclear Information System (INIS)

    Murray, J.J.

    1976-07-01

    It may be expected that solenoid magnets will be used in many storage ring experiments. Typically an insert would consist of a main solenoid at the interaction point with a symmetrical pair of compensating solenoids located somewhere between the main solenoid and the ends of the interaction region. The magnetic fields of such an insert may significantly affect storage ring performance. We suggest here a simple, systematic method for evaluation of the effects, which together with adequate design supervision and field measurements will help to prevent any serious operational problems that might result if significant perturbations went unnoticed. 5 refs

  12. A GENERAL ASSESSMENT OF CLIMATE, SOIL STRUCTURE, FOREST AREAS, GROWING STOCK AND SOME FORESTRY APPLICATIONS OF ARTVIN REGION

    OpenAIRE

    Yüksek, Turan; Ölmez, Zafer

    2011-01-01

    Artvin is located in the North Eastern Blacksea region of Turkey. Forests of Artvin are spread out from cool climate zone to cold climate zone. Artvin has approximately 390471 ha of forests, which is consist of 276883 ha (70.91%) natural forest and 113588 (29.09 %) coppice forests. Forest area covering 54.77% of total land of Artvin. Most of species of forests (natural and coppice forests) areconiferous trees, such as Picea ssp., Pinus ssp., Juniperus ssp. and broaded leaves such as Quercus s...

  13. Influence of region and site-specific factors on the degree of general validity of ecological and primary-energy-related assessments of biogas

    International Nuclear Information System (INIS)

    Dressler, Daniela

    2015-01-01

    As described in this publication, since the early 1990s numerous studies based on the life cycle assessment methodology have been dedicated to assessments of different kinds of bioenergy in comparison with fossil energy resources in terms of their energy balance and environmental impact. On reviewing the results of these studies one finds a strikingly wide range of variation. One major factor of influence on the results of life cycle assessments, besides methodological factors such as the choice of allocation method, is the representativeness of the data used. Thus, widely varying results are also obtained when balance calculations and assessments are performed on energy crops with due consideration to regional and site-specific factors. To address this problem the present study endeavoured to identify region and site-specific factors and assess them in terms of their influence on the life cycle assessment of the cultivation and conversion to biogas of different kinds of energy crops. For this purpose the following questions were explored: What influence do region, site and equipment-specific factors have on the results of ecological and primary-energy-related assessments; and how large are the differences in results between region and site-specific assessments on the one hand and assessments based on general assumptions on the other? It transpires that the results of region and site-specific assessments differ from one another in terms of both the assessment of energy cropping and the assessment of the entire process chain of biogas production and conversion to electricity.

  14. A general approach to search for supersymmetry at the LHC by combining signal enhanced kinematic regions using the ATLAS detector

    CERN Document Server

    Schneider, Basil; Weber, Michele

    The Standard Model of particle physics is a very successful theory, but it cannot describe e.g. gravity or explain the hierarchy problem. Supersymmetry is a proposed extension to the Standard Model that would solve some of its shortcomings by introducing a relation between fermions and bosons through the existence of a supersymmetric partner to every particle in the Standard Model. Since it is a broken symmetry, supersymmetric particles are heavier than their Standard Model counterparts. No supersymmetric particle has been observed to date. The ATLAS experiment at the Large Hadron Collider is a multi-purpose detector to measure parameters in the Standard Model and conduct searches for new particles. Searching for supersymmetric particles is one of the main goals of the experiment. In 2012, 20.3~fb$^{-1}$ of data at a centre-of-mass energy of $\\sqrt{s}$ = 8 TeV was collected by ATLAS. In this thesis, I analyzed the ATLAS data and developed a novel statistical approach that bins a signal enhanced region in pha...

  15. A Study of 279 General Outbreaks of Gastrointestinal Infection in the North-East Region of England

    Science.gov (United States)

    Tebbutt, Grahame M.; Wilson, Deborah; Holtby, Ian

    2009-01-01

    All outbreaks of infectious intestinal disease reported to the authorities were entered on a computer database with outbreak control teams being established to investigate larger or more significant incidents. The outbreak database and, when set up, the notes of outbreak team meetings were examined for the 279 outbreaks reported in a three-year period (2003–2005). Faeces specimens submitted as part of an outbreak were examined for microbial pathogens and the results cross-matched to the outbreak number. Almost half of the general outbreaks reported (137) occurred in long-term care facilities for the elderly, 51 outbreaks were recorded in hospitals and 31 occurred in the wider community. In 76 outbreaks no specimen was logged. A microbial cause was confirmed in about one-third of outbreaks, with noroviruses being the most common (19%). Salmonellas accounted for 12 of the 21 community outbreaks linked to social events and all were foodborne. Suggestions for improving notification and surveillance are discussed. PMID:19440398

  16. Effectiveness of combined regional-general anesthesia for reducing mortality in coronary artery bypass: meta-analysis

    Directory of Open Access Journals (Sweden)

    Fabiano Timbó Barbosa

    2016-04-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Neuraxial anesthesia (NA has been used in association with general anesthesia (GA for coronary artery bypass; however, anticoagulation during surgery makes us question the viability of benefits by the risk of epidural hematoma. The aim of this study was to perform a meta-analyzes examining the efficacy of NA associated with GA compared to GA alone for coronary artery bypass on mortality reduction. METHODS: Mortality, arrhythmias, cerebrovascular accident (CVA, myocardial infarction (MI, length of hospital stay (LHS, length of ICU stay (ICUS, reoperations, blood transfusion (BT, quality of life, satisfaction degree, and postoperative cognitive dysfunction were analyzed. The weighted mean difference (MD was estimated for continuous variables, and relative risk (RR and risk difference (RD for categorical variables. RESULTS: 17 original articles analyzed. Meta-analysis of mortality (RD = -0.01, 95% CI = -0.03 to 0.01, CVA (RR = 0.79, 95% CI = 0.32-1.95, MI (RR = 0.96, 95% CI = 0.52-1.79 and LHS (MD = -1.94, 95% CI = -3.99 to 0.12 were not statistically significant. Arrhythmia was less frequent with NA (RR = 0.68, 95% CI = 0.50-0.93. ICUS was lower in NA (MD = -2.09, 95% CI = -2.92 to -1.26. CONCLUSION: There was no significant difference in mortality. Combined NA and GA showed lower incidence of arrhythmias and lower ICUS.

  17. Sand ramps as palaeoenvironmental archives: Integrating general principles and regional contexts through reanalysis of the Klipkraal Sands, South Africa

    Science.gov (United States)

    Rowell, Alexandra L. K.; Thomas, David S. G.; Bailey, Richard M.; Holmes, Peter J.

    2018-06-01

    Sand ramps occur on a continuum of topographically-controlled landforms, ranging from purely aeolian features (climbing/falling dunes) to talus cones and alluvial fans. Sand ramps have been identified as potentially important palaeoenvironmental archives in dryland regions that possess relatively few Quaternary proxy records. Their utility however requires not only good age control of depositional phases but clear identification of process regimes, determined through morphological and sedimentological analyses, with several recent studies indicating the complexities of palaeoenvironmental interpretations and the controls of ramp development (Bateman et al., 2012; Rowell et al., 2018). Klipkraal Sands is a sand ramp on the north-eastern margin of the semi-arid Karoo that has been important for inferences of the extent of southern African Late Quaternary aeolian activity (Thomas et al., 2002). We reanalyse this feature, in the light of both its significance and other recent studies that have inferred extensive southern African LGM aeolian activity (Telfer et al., 2012, 2014). New sedimentological data and twelve OSL dates indicate the Klipkraal Sands formed episodically between 100-0.14 ka, rather than accumulating rapidly, while sedimentological data question the aeolian affinities of the bulk of the feature. Therefore, Klipkraal is reinterpreted as showing no particular affinity to the LGM, with sediments locally sourced with a significant colluvial component. Only the upper historical sediments can be clearly interpreted as aeolian deposits. A complex interplay of processes is suggested, for which a meaningful palaeoenvironmental interpretation cannot be easily defined. This implies that the local geomorphic processes and controls operating on sand ramps need to be established before they can be fully utilised as palaeoenvironmental archives, with implications for their interpretation worldwide.

  18. Cowichan Valley energy mapping and modelling. Report 4 - Analysis of opportunity costs and issues related to regional energy resilience. Final report. [Vancouver Island, Canada

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-06-15

    The driving force behind the Integrated Energy Mapping and Analysis project was the identification and analysis of a suite of pathways that the Cowichan Valley Regional District (CVRD) can utilise to increase its energy resilience, as well as reduce energy consumption and GHG emissions, with a primary focus on the residential sector. Mapping and analysis undertaken will support provincial energy and GHG reduction targets, and the suite of pathways outlined will address a CVRD internal target that calls for 75% of the region's energy within the residential sector to come from locally sourced renewables by 2050. The target has been developed as a mechanism to meet resilience and climate action target. The maps and findings produced are to be integrated as part of a regional policy framework currently under development. Based on the outputs from the first three tasks, a suite of coherent pathways towards the overall target of 75% residential local energy consumption was created, and the costs and benefits for the region were calculated. This was undertaken via a scenario analysis which also highlighted the risks and robustness of the different options within the pathways. In addition to a direct economic comparison between the different pathways, more qualitative issues were described, including potential local employment, environmental benefits and disadvantages, etc. The main tool utilised in this analysis was a tailor made Excel energy model that includes mechanisms for analysing improvements in the CVRD energy system down to an area level, for example renewable energy in residential buildings, renewable energy generation, and the effects of energy efficiency improvements. For the industrial, commercial, and transport sectors, simple and generic forecasts and input possibilities were included in the model. The Excel 'technology cost' and 'energy' models are accompanied with a user manual so that planners within the CVRD can become well

  19. Aquifers in the Sokoto basin, northwestern Nigeria, with a description of the general hydrogeology of the region

    Science.gov (United States)

    Anderson, H.R.; Ogilbee, William

    1973-01-01

    The Sokoto Basin of northwestern Nigeria lies in the sub-Saharan Sudan belt of west Africa in a zone of savannah-type vegetation. Rainfall, averaging about 30 inches annually in much of the basin, occurs chiefly in a wet season which lasts from May to October. A prolonged dry season extending from October to April is dominated by dusty harmattan winds from the northeast. April and May are the hottest months, when temperatures occasionally reach 105?F. Flow in streams of the Sokoto Basin is mostly overland runoff. Only in a few reaches, fed by ground-water discharge from the sedimentary rocks, are streams perennial. In the River Zamfara basin, ground-water discharge contributes almost 1 inch of the average 3.33 inches of total annual runoff. In the vicinity of Sokoto, the River Rima flows throughout the year sustained by spring discharge from perched ground water in limestone of the Kalambaina Formation. On the crystalline terrane where most of the streams rise, total annual runoff may exceed 5 inches, very little of which is ground-water discharge. The sedimentary rocks of the basin range in age from Cretaceous to Tertiary and are composed mostly of interbedded sand, clay, and some limestone; the beds dip gently toward the northwest. Alluvium of Quaternary age underlies the lowlands of the River Sokoto (now Sokoto) and its principal tributaries. These rocks contain three important artesian aquifers, in addition to regional unconfined ground-water bodies in all the principal outcron areas, and a perched water body in the outcrop of the Kalambaina Formation. Artesian aquifers occur at depth in the Gundumi Formation, the Rima Group, and the Gwandu Formation and are separated from one another by clay beds in the lower part of the Rima Group and the Dange Formation. In outcrop, clay in the Dange Formation also supports the perched water of the Kalambaina Formation. The Gundumi Formation, resting on the basement complex, is composed of varicolored clay, sand, and gravel

  20. The role of regional nerve block anesthesia for carotid endarterectomy: an experimental comparison with previous series with the use of general anesthesia and barbiturates for cerebral protection.

    Science.gov (United States)

    Agrifoglio, G; Agus, G B; Bonalumi, F; Costantini, A; Carlesi, R

    1987-01-01

    A retrospective analysis was performed on a consecutive series of 60 cases divided into two groups given carotid endarterectomy (C.E.) for atherosclerotic disease. In the first group general anesthesia and barbiturate cerebral protection were employed; in group two, loco-regional anesthesia. Indications and risk factors were similar in the two groups; the surgical procedure was identical. The differences in the results are reported and factors contributing to cerebral protection or reduction in the risk of stroke are analyzed. The analysis indicates that loco-regional anesthesia for C.E. is a reliable method for detecting cerebral ischemia and guaranteeing cerebral protection by means of a temporary shunt when strictly necessary.

  1. Increase in sickness absence with psychiatric diagnosis in Norway: a general population-based epidemiologic study of age, gender and regional distribution

    Directory of Open Access Journals (Sweden)

    Brage Sören

    2006-08-01

    Full Text Available Abstract Background The aim of this study was to assess the incidence of sickness absence with psychiatric diagnoses from 1994–2000, and the distribution across gender, age groups, diagnostic groups and regions in a general population. Methods The population at risk was defined as all individuals aged 16–66 years who were entitled to sickness benefits in 1994, 1996, 1998 and 2000 (n = 2,282,761 in 2000. All individuals with a full-time disability pension were excluded. The study included approximately 77% of the Norwegian population aged 16–66 years. For each year, the study base started on 1 January and ended on 31 December. Individuals that were sick-listed for more than 14/16 consecutive days with a psychiatric diagnosis on their medical certificate were selected as cases. Included in this study were data for Norway, the capital city Oslo and five regions in the southeast of the country. Results Sickness absence with psychiatric diagnoses increased in all age groups, in women and men, and in all regions. At the national level, the cumulative incidence increased in women from 1.7% in 1994 to 4.6% in 2000, and in men from 0.8% in 1994 to 2.2% in 2000. The highest cumulative incidence was found in middle-aged women and men (30–59 years. Women had a higher incidence than men in all stratification groups. The cumulative incidences in 2000 varied between 4.6% to 5.6% in women in the different regions, and for men the corresponding figures were 2.1% to 3.2%. Throughout the four years studied, women in Oslo had more than twice as high incidence levels of sickness absence with alcohol and drug diagnoses as the country as a whole. There were some differences between regions in sickness absence with specific psychiatric diagnoses, but they were small and most comparisons were non-significant. Conclusion Sickness absence with psychiatric diagnoses increased between 1994 and 2000 in Norway. The increase was highest in the middle-aged, and in women

  2. Costs, benefits, and international financing related to the water sector in the Danube and Black Sea region in the perspective of WFD implementation

    International Nuclear Information System (INIS)

    Paleari, S.

    2006-01-01

    Further to constitute a challenge far many EU15 countries, the EU Water Framework Directive (WFD) is going to represent the main reference for the process of approximation of water legislation of accession countries, as well as water policy and legislation of many third countries of Eastern Europe and Central Asia. In this work we focus on expected investment costs, estimated benefits, and external financing programmes for water policies and WFD implementation in an extensive geographical area, the Black Sea region, which includes the Danube Basin (that is the second largest European water basin after the Volga Basin) and covers industrial and agricultural areas of 22 countries. As we are primarily interested in the economic aspects of water policies and the WFD implementation in the above geographical area, we will develop a joint analysis of: (a) the available estimates on the size of investments in the water sector required to approximate the provisions and/or (depending on single countries) the principles of WFD; (b) the available estimates on the expected benefits from implementing EU water legislation and the WFD; (c) the flows of international assistance and financial resources available during the next few years for investing in water-sector infrastructures and management in the countries of the Black Sea region. The approximation of EU water legislation and the implementation of the WFD will entail huge investment costs by accession countries during the next decades and water is expected be the most significant area of investment within the environmental sector in the majority of these countries. The attempts to estimate economic and environmental benefits indicate that the same process of compliance with EU legislation and the WFD will produce significant benefits for the economy and the environment of these countries. During the last part of the I990s, however, the trends of actual expenses in environmental and water infrastructures in the countries of

  3. Referral to massage therapy in primary health care: a survey of medical general practitioners in rural and regional New South Wales, Australia.

    Science.gov (United States)

    Wardle, Jon L; Sibbritt, David W; Adams, Jon

    2013-01-01

    Massage therapists are an important part of the health care setting in rural and regional Australia and are the largest complementary and alternative medicine (CAM) profession based on both practitioner numbers and use. The purpose of this study was to survey medical general practitioners (GPs) in rural and regional New South Wales, Australia, to identify their knowledge, attitudes, relationships, and patterns of referral to massage therapy in primary health care. A 27-item questionnaire was sent to all 1486 GPs currently practicing in rural and regional Divisions of General Practice in New South Wales, Australia. The survey had 5 general areas: the GP's personal use and knowledge of massage, the GP's professional relationships with massage practice and massage practitioners, the GP's specific opinions on massage, the GP's information-seeking behavior in relation to massage, and the GP's assumptions on massage use by patients in their local areas. A total of 585 questionnaires were returned completed, with 49 survey questionnaires returned as "no longer at this address" (response rate of 40.7%). More than three-quarters of GPs (76.6%) referred to massage therapy at least a few times per year, with 12.5% of GPs referring at least once per week. The GP being in a nonremote location (odds ratio [OR], 14.28; 95% confidence interval [CI], 3.7-50.0), graduating from an Australian medical school (OR, 2.03; 95% CI, 1.09-3.70), perceiving a lack of other treatment options (OR, 2.64; 95% CI, 1.15-6.01), perceiving good patient access to a wide variety of medical specialists (OR, 11.1; 95% CI, 1.7-50.0), believing in the efficacy of massage therapy (OR, 2.75; 95% CI, 1.58-4.78), experiencing positive results from patients using massage therapy previously (OR, 13.95; 95% CI, 5.96-32.64), or having prescribed any CAM previously (OR, 1.83; 95% CI, 1.03-3.27) were all independently predictive of increased referral to massage therapy among the GPs in this study. There appears to

  4. Socioeconomic disadvantage and its implications for population health planning of obesity and overweight, using cross-sectional data from general practices from a regional catchment in Australia.

    Science.gov (United States)

    Ghosh, Abhijeet; Charlton, Karen E; Batterham, Marijka J

    2016-05-03

    To identify smaller geographic and region-specific evidence to inform population health planning for overweight and obesity. Cross-sectional secondary analysis of data. Primary healthcare-17 general practices located in the Illawarra-Shoalhaven region of New South Wales (NSW). A subset (n=36 674) of the Sentinel Practices Data Sourcing project adult persons data set (n=118 794) that included information on disease status of all adult patients who had height and weight measurements recorded in their electronic health records and had visited the included general practices within the Illawarra-Shoalhaven region of NSW between September 2011 and September 2013. Age-adjusted odds ratio (aOR) of overweight and obesity was determined for high and low levels of socioeconomic disadvantage based on Socio-Economic Indexes for Areas (SEIFA)-Index of Relative Socio-Economic Disadvantage (IRSD) scores of patients' residential statistical local area. In men, overweight was lowest in areas of highest socioeconomic disadvantage (aOR=0.910; 95% CI 0.830 to 0.998; pdisadvantage (aOR=1.292; 95% CI 1.210 to 1.379; pdata analysis reveals multiple layers of evidence that should be assessed for population health approaches to curb the epidemic of obesity and overweight. It strongly highlights the need for preventive health initiatives to be specific to gender and socioeconomic attributes of the target population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia.

    Science.gov (United States)

    Wardle, J; Adams, J; Sibbritt, D

    2013-07-01

    Homeopathy has attracted considerable recent attention from the Australian conventional medical community. However, despite such increased attention there has been little exploration of the interface between homeopathy and Australian conventional medical practice. This article addresses this research gap by exploring homeopathic practice and referral by rural and regional Australian general practitioners (GPs). A 27-item questionnaire was sent to all 1486 GPs currently practising in rural and regional New South Wales, Australia (response rate 40.7%). Few GPs in this study utilised homeopathy in their personal practice, with only 0.5% of GPs prescribing homeopathy in the past 12 months, and 8.5% referring patients for homeopathic treatment at least a few times over the past 12 months. Nearly two-thirds of GPs (63.9%) reported that they would not refer for homeopathy under any circumstances. Being in a remote location, receiving patient requests for homeopathy, observing positive responses from homeopathy previously, using complementary and alternative medicine (CAM) practitioners as information sources, higher levels of knowledge of homeopathy, and being interested in increasing CAM knowledge were all independently predictive of increased referral to homeopathy amongst GPs in this study. GPs in this study were less likely to refer to homeopathy if they used peer-reviewed literature as the major source of their information on CAM. Homeopathy is not integrated significantly in rural general practice either via GP utilisation or referral. There is significant opposition to homeopathy referral amongst rural and regional GPs, though some level of interaction with homeopathic providers exists. Copyright © 2013 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  6. Cerebral oxygenation in patients undergoing shoulder surgery in beach chair position: comparing general to regional anesthesia and the impact on neurobehavioral outcome.

    Science.gov (United States)

    Aguirre, J; Borgeat, A; Trachsel, T; Cobo Del Prado, I; De Andrés, J; Bühler, P

    2014-02-01

    Ischemic brain damage has been reported in healthy patients after beach chair position for surgery due to cerebral hypoperfusion. Near-infrared spectroscopy has been described as a non-invasive, continuous method to monitor cerebral oxygen saturation. However, its impact on neurobehavioral outcome comparing different anesthesia regimens has been poorly described. In this prospective, assessor-blinded study, 90 patients undergoing shoulder surgery in beach chair position following general (G-group, n=45) or regional anesthesia (R-group; n=45) were enrolled to assess the prevalence of cerebral desaturation events comparing anesthesia regimens and their impact on neurobehavioral and neurological outcome. Anesthesiologists were blinded to regional cerebral oxygen saturation values. Baseline data assessed the day before surgery included neurological and neurobehavioral tests, which were repeated the day after surgery. The baseline data for regional cerebral oxygen saturation/bispectral index and invasive blood pressure both at heart and auditory meatus levels were taken prior to anesthesia, 5 min after induction of anesthesia, 5 min after beach chair positioning, after skin incision and thereafter all 20 min until discharge. Patients in the R-group showed significantly less cerebral desaturation events (psurgery (pshoulder surgery in beach chair position influencing neurobehavioral test results at 24h. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  7. Trojan Decommissioning Project Cost Performance

    International Nuclear Information System (INIS)

    Michael B. Lackey

    2000-01-01

    The Trojan nuclear plant (Trojan) was an 1160-MW(electric) four-loop pressurized water reactor located in Rainier, Oregon. The plant was permanently shut down in 1993 after ∼17 yr of commercial operation. The early plant closure was an economic decision. The key factors in the closure analysis were escalation of inspection and repair costs associated with steam generator tube cracking and the projected availability of inexpensive replacement power in the Pacific Northwest region of the United States. Since the plant closure, Portland General Electric (PGE) has been actively engaged in decommissioning. The Trojan Decommissioning Project currently has a forecast at completion of $429.7 million (all costs are in millions of 1997 dollars, unless otherwise noted). The cost performance of the Trojan Decommissioning Project to date is addressed, as well as the tools that are in place to provide cost control through completion of decommissioning

  8. Lowering the UK domestic radon action level to reduce radiation-induced lung cancer in general population: when and where is it cost effective?

    International Nuclear Information System (INIS)

    Denman, A.R.; Phillips, P.S.

    2008-01-01

    Case studies have shown that radon gas can be present within domestic properties at sufficiently high levels that it can significantly increase the risk of lung cancer in occupants. Recently, Darby et al. (2006) have shown that this risk exists at radon concentrations as low as 100 Bq·m -3 , which is below the UK domestic Action Level of 200 Bq·m -3 . As a result, there have been suggestions that national domestic Action Levels should be reduced. This paper considers the benefits and costs of the domestic radon remediation programmes in the UK, when a range of Action Levels from 125 Bq·m -3 to 600 Bq·m -3 are applied. The variations of total cost, cost-effectiveness, dose reduction and lung cancers saved for each proposed action level, and the proportion of houses over the proposed action level, were estimated. The study shows that, for an Action Level above 200 Bq·m -3 , a completed domestic radon remediation programme in Northamptonshire, where 6.3% of existing houses have initial radon levels over 200 Bq·m -3 , will cost less and will target those most at risk, but will be less cost effective. In addition, a higher Action Level leaves a higher residual dose and greater risk of cancer in the population living in unremediated homes. Reducing the Action Level below 200 Bq·m -3 will prevent more cancers, but at significantly higher cost. It will be less cost-effective, because a significant number of houses with moderate radon levels will be remediated with modest health benefit to occupants. The study suggests that a completed radon remediation programme is most cost-effective with an action level of around 250 to 300 Bq·m -3 . The finding appears to be independent of the percentage of houses over the Action Level. This has clear implications for future health policy. (author)

  9. Atmospheric weighting functions and surface partial derivatives for remote sensing of scattering planetary atmospheres in thermal spectral region: general adjoint approach

    International Nuclear Information System (INIS)

    Ustinov, Eugene A.

    2005-01-01

    An approach to formulation of inversion algorithms for remote sensing in the thermal spectral region in the case of a scattering planetary atmosphere, based on the adjoint equation of radiative transfer (Ustinov (JQSRT 68 (2001) 195; JQSRT 73 (2002) 29); referred to as Papers 1 and 2, respectively, in the main text), is applied to the general case of retrievals of atmospheric and surface parameters for the scattering atmosphere with nadir viewing geometry. Analytic expressions for corresponding weighting functions for atmospheric parameters and partial derivatives for surface parameters are derived. The case of pure atmospheric absorption with a scattering underlying surface is considered and convergence to results obtained for the non-scattering atmospheres (Ustinov (JQSRT 74 (2002) 683), referred to as Paper 3 in the main text) is demonstrated

  10. Part B Excess Cost Quick Reference Document

    Science.gov (United States)

    Ball, Wayne; Beridon, Virginia; Hamre, Kent; Morse, Amanda

    2011-01-01

    This Quick Reference Document has been prepared by the Regional Resource Center Program ARRA/Fiscal Priority Team to aid RRCP State Liaisons and other (Technical Assistance) TA providers in understanding the general context of state questions surrounding excess cost. As a "first-stop" for TA providers in investigating excess cost…

  11. An idealized radiative transfer scheme for use in a mechanistic general circulation model from the surface up to the mesopause region

    International Nuclear Information System (INIS)

    Knoepfel, Rahel; Becker, Erich

    2011-01-01

    A new and numerically efficient method to compute radiative flux densities and heating rates in a general atmospheric circulation model is presented. Our method accommodates the fundamental differences between the troposphere and middle atmosphere in the long-wave regime within a single parameterization that extends continuously from the surface up to the mesopause region and takes the deviations from the gray limit and from the local thermodynamic equilibrium into account. For this purpose, frequency-averaged Eddington-type transfer equations are derived for four broad absorber bands. The frequency variation inside each band is parameterized by application of the Elsasser band model extended by a slowly varying envelope function. This yields additional transfer equations for the perturbation amplitudes that are solved numerically along with the mean transfer equations. Deviations from local thermodynamic equilibrium are included in terms of isotropic scattering, calculating the single scattering albedo from the two-level model for each band. Solar radiative flux densities are computed for four energetically defined bands using the simple Beer-Bougert-Lambert relation for absorption within the atmosphere. The new scheme is implemented in a mechanistic general circulation model from the surface up to the mesopause region. A test simulation with prescribed concentrations of the radiatively active constituents shows quite reasonable results. In particular, since we take the full surface energy budget into account by means of a swamp ocean, and since the internal dynamics and turbulent diffusion of the model are formulated in accordance with the conservation laws, an equilibrated climatological radiation budget is obtained both at the top of the atmosphere and at the surface.

  12. General Ultrasound Imaging

    Medline Plus

    Full Text Available ... This website does not provide cost information. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. Discuss the fees associated with your prescribed procedure with your doctor, ...

  13. Regional integration of developing countries. Interview with Amr Moussa, the Secretary General of the League of Arab States (2001-2011

    Directory of Open Access Journals (Sweden)

    E M Savicheva

    2017-12-01

    Full Text Available Amr Mussa is one of the most experienced diplomats with rich experience in international organizations. In 1958 Mr. Moussa joined the Ministry of Foreign Affairs of Egypt, where he worked in several departments and Egyptian missions including Egypt’s UN mission (1985-1972. In 1974-1977 Amr Moussa was an Assistant and Advisor to the Minister for Foreign Affairs of the Arab Republic of Egypt. In 1977-1981 and 1986-1990 he held office of the Department of International Organizations as the Director in the Ministry of Foreign Affairs of Egypt. In 1981-1983 Mr. Moussa was an Alternate Permanent Representative of Egypt to the United Nations in New York. In 1983-1986 he worked as Ambassador to India. Amr Moussa worked as Permanent Representative of the Arab Republic of Egypt to the United Nations in 1990-1991. In 1991-2001 he was a head of the Ministry of Foreign Affairs of Egypt. In 2001-2011 he worked as Secretary General of the League of Arab States. In his interview, Mr. Amr Moussa talks about the role of international organizations in the developing world, the peculiarities of regional political and economic integration of developing countries. Particular attention is paid to the problems of peacekeeping activities at the regional level.

  14. Seroprevalence and risk factors of Kaposi's sarcoma-associated herpesvirus infection among the general Uygur population from south and north region of Xinjiang, China

    Directory of Open Access Journals (Sweden)

    Wang Hui

    2011-12-01

    Full Text Available Abstract Background Kaposi sarcoma (KS is a complex multifocal neoplasm and is the major cause of death for about 50% of acquired immunodeficiency syndrome (AIDS patients. Kaposi's sarcoma-associated herpesvirus (KSHV is an oncogenic virus with a causal role in the development of all types of KS. KS is prevalent among the Uygur people in Xinjiang, especially in south area. Here we carried out a cross-sectional study among 1534 general Uygur individuals from south and north region of Xinjiang to assess the seroprevalence of KSHV and to identify the potential correlation between KSHV seroprevalence and KS incidence. Results Seroprevalence of KSHV in South and North Xinjiang was 23.1% and 25.9%, respectively. Older age was independently associated with higher KSHV seroprevalence. In subjects from South Xinjiang, lower educational level and reported drinking were each independently associated with higher KSHV seroprevalence. Furthermore, the antibody titer was significantly lower in both south and north KSHV seropositive individuals compared with KS patients, as analyzed by gradient dilution (P Conclusion KSHV is highly prevalent in the general Uygur population in both South and North Xinjiang. Interestingly, the infection rate of KSHV in these two geographical areas did not correlate well with KS incidence. Perhaps unknown factors exist that promote the progression of KSHV infection to KS development in the local minority groups.

  15. Validity of silhouette showcards as a measure of body size and obesity in a population in the African region: A practical research tool for general-purpose surveys.

    Science.gov (United States)

    Yepes, Maryam; Viswanathan, Barathi; Bovet, Pascal; Maurer, Jürgen

    2015-01-01

    The purpose of this study is to validate the Pulvers silhouette showcard as a measure of weight status in a population in the African region. This tool is particularly beneficial when scarce resources do not allow for direct anthropometric measurements due to limited survey time or lack of measurement technology in face-to-face general-purpose surveys or in mailed, online, or mobile device-based surveys. A cross-sectional study was conducted in the Republic of Seychelles with a sample of 1240 adults. We compared self-reported body sizes measured by Pulvers' silhouette showcards to four measurements of body size and adiposity: body mass index (BMI), body fat percent measured, waist circumference, and waist to height ratio. The accuracy of silhouettes as an obesity indicator was examined using sex-specific receiver operator curve (ROC) analysis and the reliability of this tool to detect socioeconomic gradients in obesity was compared to BMI-based measurements. Our study supports silhouette body size showcards as a valid and reliable survey tool to measure self-reported body size and adiposity in an African population. The mean correlation coefficients of self-reported silhouettes with measured BMI were 0.80 in men and 0.81 in women (P general-purpose surveys of obesity in social sciences, where limited resources do not allow for direct anthropometric measurements.

  16. A Cost-Benefit Analysis on the Feasibility of Implementing A Same-Day Surgery Program at the 121ST General Hospital, Seoul, Korea

    Science.gov (United States)

    2000-04-27

    complete my research include the following: Mr. Craig Carter, LTC Jane Denio, Ms. Patricia Felder, Mr. Al Rayos , Mr. Modesto Rivera, Mrs. Helen Shinn...3,100,392, calculated as such: (*Average DRG Cost x 894) – (*Average SDS Cost x 894) = $3,100,392 There were 22 cases that could be clearly identified as a... x 1. INTRODUCTION…………………………………………………..…… 1 Conditions Which Prompted the Study……………………….…. 2 Statement of the Problem

  17. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice : protocol of a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    van der Zweerde, Tanja; Lancee, Jaap; Slottje, Pauline; Bosmans, Judith; Van Someren, Eus; Reynolds, Charles; Cuijpers, Pim; van Straten, Annemieke

    2016-01-01

    BACKGROUND: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often.

  18. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    van der Zweerde, T.; Lancee, J.; Slottje, P.; Bosmans, J.; van Someren, E.; Reynolds, C.; Cuijpers, Pim; van Straten, A.

    2016-01-01

    BACKGROUND: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often.

  19. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice : Protocol of a pragmatic randomized controlled trial

    NARCIS (Netherlands)

    van der Zweerde, T.; Lancee, J.; Slottje, P.; Bosmans, J.; Van Someren, E.; Reynolds, C.; Cuijpers, P.; van Straten, A.

    2016-01-01

    Background: Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often.

  20. Examination of aerosol distributions and radiative effects over the Bay of Bengal and the Arabian Sea region during ICARB using satellite data and a general circulation model

    Directory of Open Access Journals (Sweden)

    R. Cherian

    2012-02-01

    Full Text Available In this paper we analyse aerosol loading and its direct radiative effects over the Bay of Bengal (BoB and Arabian Sea (AS regions for the Integrated Campaign on Aerosols, gases and Radiation Budget (ICARB undertaken during 2006, using satellite data from the MODerate Resolution Imaging Spectroradiometer (MODIS on board the Terra and Aqua satellites, the Aerosol Index from the Ozone Monitoring Instrument (OMI on board the Aura satellite, and the European-Community Hamburg (ECHAM5.5 general circulation model extended by Hamburg Aerosol Module (HAM. By statistically comparing with large-scale satellite data sets, we firstly show that the aerosol properties measured during the ship-based ICARB campaign and simulated by the model are representative for the BoB and AS regions and the pre-monsoon season. In a second step, the modelled aerosol distributions were evaluated by a comparison with the measurements from the ship-based sunphotometer, and the satellite retrievals during ICARB. It is found that the model broadly reproduces the observed spatial and temporal variability in aerosol optical depth (AOD over BoB and AS regions. However, AOD was systematically underestimated during high-pollution episodes, especially in the BoB leg. We show that this underprediction of AOD is mostly because of the deficiencies in the coarse mode, where the model shows that dust is the dominant component. The analysis of dust AOD along with the OMI Aerosol Index indicate that missing dust transport that results from too low dust emission fluxes over the Thar Desert region in the model caused this deficiency. Thirdly, we analysed the spatio-temporal variability of AOD comparing the ship-based observations to the large-scale satellite observations and simulations. It was found that most of the variability along the track was from geographical patterns, with a minor influence by single events. Aerosol fields were homogeneous enough to yield a good statistical agreement

  1. Prevalence of pain in the orofacial regions in patients visiting general dentists in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry research network.

    Science.gov (United States)

    Horst, Orapin V; Cunha-Cruz, Joana; Zhou, Lingmei; Manning, Walter; Mancl, Lloyd; DeRouen, Timothy A

    2015-10-01

    This study aimed to measure prevalence of pain in the orofacial regions and determine association with demographics, treatment history, and oral health conditions in dental patients visiting clinics in the Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry (PRECEDENT) research network. Data were recorded in a survey with systematic random sampling of patients (n = 1,668, 18 to 93 years old, 56% female) visiting 100 general dentists in the Northwest PRECEDENT research network. Prevalence ratios (PR) of orofacial pain by each variable were estimated by generalized estimating equations for Poisson regression. The prevalence of orofacial pain during the past year was 16.1% (95% confidence interval [CI], 13.4-18.9), of which the most prevalent pain locations were dentoalveolar (9.1%; 95% CI, 7.0-11.2) and musculoligamentous tissues (6.6%; 95% CI, 4.5-8.7). Other locations included soft tissues (0.5%; 95% CI, 0.2-0.8) and nonspecific areas (0.6%; 95% CI, 0.2-1.0). The prevalence of dentoalveolar but not musculoligamentous pain decreased with age. When comparing the 18- to 29-year-old patients, dentoalveolar pain decreased significantly in 45- to 64-year-old patients (PR, 0.59; 95% CI, 0.4-0.9) and in those 65 years or older (PR, 0.5; 95% CI, 0.3-0.9). Sex significantly affected the prevalence of musculoligamentous but not dentoalveolar pain. Women (PR, 3.2; 95% CI, 2.0-5.1) were more likely to have musculoligamentous pain. The prevalence of dentoalveolar and musculoligamentous pain did not vary significantly by ethnicity. Dentoalveolar pain was reported more frequently in patients who did not receive dental maintenance (PR, 2.9; 95% CI, 2.1-4.2) and those visiting community-based public health clinics (PR, 2.2; 95% CI, 1.2-3.7). One in 6 patients visiting a general dentist had experienced orofacial pain during the past year. Dentoalveolar and musculoligamentous pains were the most prevalent types of pain. Pain in the muscles and

  2. Effect of a French experiment of team work between general practitioners and nurses on efficacy and cost of type 2 diabetes patients care.

    Science.gov (United States)

    Mousquès, Julien; Bourgueil, Yann; Le Fur, Philippe; Yilmaz, Engin

    2010-12-01

    To assess the efficacy and the cost of a French team work experiment between nurses and GPs for managing type 2 diabetes patients. Based on a case control study design we compare the evolution of process (standard follow-up procedures) and final (glycemic control) outcomes, and of cost, between two consecutive periods between type 2 diabetes patients followed within the team work experiment (intervention group) or by "standard" GPs (controlled group). After a 11 months of follow-up, patients in the intervention group, compared with those in the controlled group, have more chances to remain or to become: correctly followed-up (with OR comprise between 2.1 and 6.8, p≤5%) and under glycemic control (with OR comprise between 1.8 and 2.7, p≤5%). The latter result is obtained only when a visit for education and counselling has been delivered by a nurse in supplement to systematic electronic patient registry and electronic clinical GPs reminder. All these results are obtained without difference in costs between the intervention and the controlled group. This experimentation of team working can be considered both effective and efficient. Our findings may have implications in the design of future larger primary care team work experiment to be launched by French health authorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  3. Diagnostic pathway of syncope and analysis of the impact of guidelines in a district general hospital. The ECSIT study (epidemiology and costs of syncope in Trento).

    Science.gov (United States)

    Del Greco, Maurizio; Cozzio, Susanna; Scillieri, Marco; Caprari, Francesca; Scivales, Alessandro; Disertori, Marcello

    2003-02-01

    The ECSIT study was aimed at evaluating the hospital management of syncope patients, at comparing the appropriateness and costs of the hospital diagnostic pathway before (phase 1) and after (phase 2) the introduction of new guidelines and at analyzing the physicians' compliance to the guidelines. All syncope patients admitted to the emergency room between August 1 and October 31, 1999 (phase 1) and between March 1 and May 31, 2000 (phase 2) were enrolled and their clinical records were analyzed in a blind fashion. During the study 538 consecutive patients came to the emergency room for syncope with a hospitalization rate of 53% in phase 1 (n = 151) and of 42% in phase 2 (n = 107). The in-hospital stay increased from 9 days in phase 1 to 11.3 days in phase 2 and diagnostic tests from 2.6 per patient (phase 1) to 2.9 per patient (phase 2) with total costs that rose from [symbol: see text] 3,474 to [symbol: see text] 3,647. Patients with no diagnosis decreased from 51 to 45.8% and the principal causes were identified as vascular brain disease (36.1 vs 33.7%) and neurally-mediated mechanisms (35.3 vs 42.2%). Despite the high costs of syncope management, the appropriateness and efficacy of the hospital diagnostic pathway remains far from ideal and simply introducing new guidelines seems unable to modify clinical practice.

  4. Prevalence of underweight, overweight, general and central obesity among 8-15-years old Bulgarian children and adolescents (Smolyan region, 2012-2014).

    Science.gov (United States)

    Mladenova, Silviya; Andreenko, Emiliya

    2015-06-01

    The objective of this work is to investigate the distribution of underweight, overweight, the general and central obesity in 8-15-year-old Bulgarian children and adolescents, through the use of the anthropometric indices BMI and WHtR. Subject of this study are 878 children and adolescents (437 boys and 441 girls) of Smolyan region, Bulgaria, at the age of 8 to 15 years. The study is cross-sectional and was conducted in the period 2012-2014. The body height, weight and waist circumference were measured. In addition, the body mass index (BMI) and waist to height ratio (WHtR) were calculated. Overweight and obesity were defined according to the cut-off points of BMI, recommended of IOTF and developed by Cole et al. (2000; 2007). The central obesity was defined according to the discriminatory values of 0.500 of WHtR. The collected data were analysed by statistical software packages STATISTICA 10.0 and SPSS 16. Overweight occurs among 18.8% of the boys and 17.0% of the girls, and obesity occurs among 7.6% of boys and 3.7% of the girls. The underweight are 8.0% of the boys and 10.4% of the girls. Central obesity (WHtR ≥ 0.500) occur among average 12.75% of all investigated children independently of their nutritional status (16.2% of boys and 9.3% of girls). With central obesity (WHtR ≥ 0.500) are on average 2.7% of all boys and girls with normal weight (n = 96) and an average 46.82% of all participants with overweight and with obesity (n = 205). With increased health risk (WHtR ≥ 0.500) are total of 2.01% (n=16) of all surveyed children (n = 793) from categories normal weight. There has been an increase in prevalence of overweight and obesity among Bulgarian children and adolescents from Smolyan region during the over one last decade. The relatively high percentage of underweight children, especially among in group of the girls alter puberty. The central obesity, as well as its combination with overweight or general obesity is more frequent in boys than in girls

  5. Regional Versus General Anesthesia and the Incidence of Unplanned Health Care Resource Utilization for Postoperative Pain After Wrist Fracture Surgery: Results From a Retrospective Quality Improvement Project.

    Science.gov (United States)

    Sunderland, Sarah; Yarnold, Cynthia H; Head, Stephen J; Osborn, Jill A; Purssell, Andrew; Peel, John K; Schwarz, Stephan K W

    2016-01-01

    The establishment at our center of a dedicated regional anesthesia service in 2008-2009 has resulted in a marked increase in single-shot brachial plexus blocks (sBPBs) for ambulatory wrist fracture surgery. Despite the documented benefits of regional over general anesthesia (GA), there has been a perceived increase among sBPB patients in postoperative return rates for pain at our institution. We conducted a retrospective quality improvement project to examine this. After exemption from human ethics board review, we sought to identify and contact all wrist fracture surgery patients treated at our center between 2003 and 2012. Our primary outcome was the incidence of unplanned physician visits (office/clinic or emergency department) for pain in the first 48 hours after surgery. Other main outcomes included the incidence of seeking any form of medical attention for pain and self-reporting of severe pain in the first 48 hours. Of 1008 identified patients, 419 could be contacted; 195 qualified for analysis. The incidence of unplanned physician visits in the first 48 hours was 12% (13 of 118) among sBPB patients versus 4% (3 of 77) in GA patients (odds ratio [OR], 3.1; 95% confidence interval [95% CI], 0.8-11.1; P = 0.11). More sBPB versus GA patients sought any form of medical attention for pain (20% vs 5%; OR, 4.7; 95% CI, 1.4-10.9; P = 0.003). Similarly, more sBPB patients reported severe postoperative pain (41% vs 10%; OR, 5.9; 95% CI, 2.6-13.4; P resource utilization caused by pain after hospital discharge than those undergoing GA. These findings warrant confirmation in a prospective trial and emphasize the need for a defined postdischarge analgesic pathway as well as the potential merits of perineural home catheters.

  6. Future discharge drought across climate regions around the world modelled with a synthetic hydrological modelling approach forced by three general circulation models

    Science.gov (United States)

    Wanders, N.; Van Lanen, H. A. J.

    2015-03-01

    Hydrological drought characteristics (drought in groundwater and streamflow) likely will change in the 21st century as a result of climate change. The magnitude and directionality of these changes and their dependency on climatology and catchment characteristics, however, is uncertain. In this study a conceptual hydrological model was forced by downscaled and bias-corrected outcome from three general circulation models for the SRES A2 emission scenario (GCM forced models), and the WATCH Forcing Data set (reference model). The threshold level method was applied to investigate drought occurrence, duration and severity. Results for the control period (1971-2000) show that the drought characteristics of each GCM forced model reasonably agree with the reference model for most of the climate types, suggesting that the climate models' results after post-processing produce realistic outcomes for global drought analyses. For the near future (2021-2050) and far future (2071-2100) the GCM forced models show a decrease in drought occurrence for all major climates around the world and increase of both average drought duration and deficit volume of the remaining drought events. The largest decrease in hydrological drought occurrence is expected in cold (D) climates where global warming results in a decreased length of the snow season and an increased precipitation. In the dry (B) climates the smallest decrease in drought occurrence is expected to occur, which probably will lead to even more severe water scarcity. However, in the extreme climate regions (desert and polar), the drought analysis for the control period showed that projections of hydrological drought characteristics are most uncertain. On a global scale the increase in hydrological drought duration and severity in multiple regions will lead to a higher impact of drought events, which should motivate water resource managers to timely anticipate the increased risk of more severe drought in groundwater and streamflow

  7. Predictors of failure of awake regional anesthesia for neonatal hernia repair: data from the General Anesthesia compared to Spinal anesthesia (GAS) study: comparing apnoea and neurodevelopmental outcomes

    Science.gov (United States)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E.; de Graaff, Jurgen C.; Morton, Neil S.; McCann, Mary Ellen; Arnup, Sarah J.; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J.

    2015-01-01

    Background Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes. The General Anesthesia compared to Spinal anesthesia (GAS) study compares neurodevelopmental outcomes following awake RA or GA in otherwise healthy infants. Our aim was to describe success and failure rates of RA in this study and report factors associated with failure. Methods This was a nested cohort study within a prospective randomized, controlled, observer blind, equivalence trial. Seven hundred twenty two infants ≤ 60 weeks postmenstrual age, scheduled for herniorrhaphy under anesthesia were randomly assigned to receive RA (spinal, caudal epidural or combined spinal caudal anesthetic) or GA with sevoflurane. The data of 339 infants, where spinal or combined spinal caudal anesthetic was attempted, was analyzed. Possible predictors of failure were assessed including: patient factors, technique, experience of site and anesthetist and type of local anesthetic. Results RA was sufficient for the completion of surgery in 83.2% of patients. Spinal anesthesia was successful in 86.9% of cases and combined spinal caudal anesthetic in 76.1%. Thirty four patients required conversion to GA and an additional 23 (6.8%) required brief sedation. Bloody tap on the first attempt at lumbar puncture was the only risk factor significantly associated with block failure (OR = 2.46). Conclusions The failure rate of spinal anesthesia was low. Variability in application of combined spinal caudal anesthetic limited attempts to compare the success of this technique to spinal alone. PMID:26001028

  8. The determinants of patient waiting time in the general outpatient department of Debre Markos and Felege Hiwot hospitals in Amhara regional state, North West, Ethiopia

    Directory of Open Access Journals (Sweden)

    Melesse Belayneh

    2017-01-01

    Full Text Available Background Patient waiting time is defined as the total time from registration until consultation with a doctor. Experiences of waiting in general are perceived as complex, subjective, and culturally influenced. Registration time, payment process/cash billing, recording classification/triaged time, few human resources and work process are the determinants of patient waiting time in the general outpatient departments. However, the complexity of wait time is poorly understood and has been explored only to a limited extent. The main objective of this study to assess patient waiting time and its determinants in Debre Markos and Felge Hiwot Referral hospitals of Amhara Regional State in North West, Ethiopia. Methods A hospital based comparative cross sectional study design was employed from October 20‐ November 20, 2014. The study population was patients presenting to general outpatient departments, from which 464 patients was selected using systematic random sampling technique. Quantitative Data was collected using structured questionnaire and A check list adopted from studies. Quantitative data was coded, entered, cleaned and analyzed using SPSS Software for windows version 20.0. Linear regression and bivariate logistic regression was applied to identify the determinants of each explanatory variable on outcome (patient waiting time. Finally data was interpreted by referring to the pertinent findings from the relevant literature reviewed. Ethical approval and clearance was obtained from ethical clearance committee of the Jimma University College of Public Health & Medical Sciences Result The measured waiting time in Felge Hiwot referral hospital mean waiting time was and its standard deviation 149.2±72.1 minutes whereas 94.2±58.3 minutes in debere markos referral hospital. The major causes of the long patient waiting time was large numbers of patient with a few doctors 94(40.5%,67(28.9% ,long searching of the cards 67(28.9%,73(31.5,and long

  9. A cost-effectiveness analysis of fistula treatment in the abdominal region using a new integrated fistula and wound management system

    DEFF Research Database (Denmark)

    Keiding, Hans; Skovgaard, Rasmus

    2008-01-01

    OBJECTIVE: To evaluate wear time and costs of a new fistula and wound management system (FWMS) compared to standard fistula treatments. METHODS: Data were collected from 22 patients with an abdominal fistula recruited from 5 sites in the United States. This economic evaluation was based on a cost...

  10. Comparative review of three cost-effectiveness models for rotavirus vaccines in national immunization programs; a generic approach applied to various regions in the world

    NARCIS (Netherlands)

    Postma, Maarten J.; Jit, Mark; Rozenbaum, Mark H.; Standaert, Baudouin; Tu, Hong-Anh; Hutubessy, Raymond C. W.

    2011-01-01

    Background: This study aims to critically review available cost-effectiveness models for rotavirus vaccination, compare their designs using a standardized approach and compare similarities and differences in cost-effectiveness outcomes using a uniform set of input parameters. Methods: We identified

  11. Case studies, cross-site comparisons, and the challenge of generalization: comparing agent-based models of land-use change in frontier regions.

    Science.gov (United States)

    Parker, Dawn C; Entwisle, Barbara; Rindfuss, Ronald R; Vanwey, Leah K; Manson, Steven M; Moran, Emilio; An, Li; Deadman, Peter; Evans, Tom P; Linderman, Marc; Rizi, S Mohammad Mussavi; Malanson, George

    2008-01-01

    Cross-site comparisons of case studies have been identified as an important priority by the land-use science community. From an empirical perspective, such comparisons potentially allow generalizations that may contribute to production of global-scale land-use and land-cover change projections. From a theoretical perspective, such comparisons can inform development of a theory of land-use science by identifying potential hypotheses and supporting or refuting evidence. This paper undertakes a structured comparison of four case studies of land-use change in frontier regions that follow an agent-based modeling approach. Our hypothesis is that each case study represents a particular manifestation of a common process. Given differences in initial conditions among sites and the time at which the process is observed, actual mechanisms and outcomes are anticipated to differ substantially between sites. Our goal is to reveal both commonalities and differences among research sites, model implementations, and ultimately, conclusions derived from the modeling process.

  12. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  13. Complicações e seqüelas neurológicas da anestesia regional realizada em crianças sob anestesia geral: um problema real ou casos esporádicos? Complicaciones y secuelas neurológicas de la anestesia regional realizada en niños bajo anestesia general: ¿ Un problema real o casos esporádicos? Neurological complications and damage of regional block in children under general anesthesia: a real problem or sporadic cases?

    Directory of Open Access Journals (Sweden)

    Verônica Vieira da Costa

    2006-12-01

    mayoría de las veces se realiza después de la anestesia general, sea realmente segura. Existe el riesgo potencial de una lesión neurológica permanente o temporal cuando el paciente no puede informar la eventual parestesia o dolor, durante la realización de la anestesia regional, lo que genera inseguridad por parte de los anestesiólogos. El objetivo de este estudio fue el de evaluar la prevalencia de complicaciones y de secuelas neurológicas de la anestesia regional en niños bajo anestesia general. MÉTODO: En un análisis prospectivo se estudiaron niños sometidos a intervenciones quirúrgicas ortopédica y plástica reparadora bajo anestesia regional asociada a la anestesia general. La inducción y el mantenimiento de la anestesia fueron por vía venosa o por inhalación. Después de la anestesia general se realizaba anestesia regional y se evaluaba la existencia de complicaciones inmediatas, el número de punciones realizadas, complicaciones de medio plazo y la presencia de secuelas neurológicas. RESULTADOS: En un período de 13 meses se estudiaron 499 niños de los dos sexos, con edad promedio entre 6 y 7 años. La mayoría de los pacientes se sometió a la anestesia general asociada a la peridural lumbar o caudal. La prevalencia de complicación inmediata fue de un 3,6%, siendo la más frecuente el sangramiento al momento de la punción. La prevalencia de complicaciones en medio plazo fue de un 1,1%, siendo la más frecuente la hipoestesia y no hubo secuela neurológica a largo plazo. CONCLUSIONES: Los resultados del presente estudio están a tono con los de otros autores con relación a la baja prevalencia de complicaciones de la anestesia regional en niños bajo anestesia general, sin dejar secuelas neurológicas. Eso puede ser atribuido al uso de material adecuado y a la experiencia del equipo de anestesia.BACKGROUND AND METHODS: It has been questioned whether regional block in children, which most of the time is done under general anesthesia, is really

  14. Cost-utility of collaborative care for the treatment of comorbid major depressive disorder in outpatients with chronic physical conditions. A randomized controlled trial in the general hospital setting (CC-DIM

    Directory of Open Access Journals (Sweden)

    Goorden M

    2017-07-01

    Full Text Available Maartje Goorden,1 Christina M van der Feltz-Cornelis,2,3 Kirsten M van Steenbergen-Weijenburg,4 Eva K Horn,5 Aartjan TF Beekman,6,7 Leona Hakkaart-van Roijen1 1Institute of Health Policy and Management (iBMG/Institute for Medical Technology Assessment (iMTA, Erasmus University Rotterdam, Rotterdam, 2Tranzo Department, Tilburg University, 3Clinical Centre of Excellence for Body, Mind and Health, GGzBreburg, Tilburg, 4Trimbos Instituut, Utrecht, 5Viersprong Institute for Studies on Personality Disorders, Halsteren, 6Department of Psychiatry, 7EMGO+ Research Institute VUmc, VU University Medical Centre, Amsterdam, the Netherlands Purpose: Major depressive disorder (MDD is highly prevalent in patients with a chronic physical condition, and this comorbidity has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Research has shown that collaborative care (CC may be a cost-effective treatment. However, its cost-effectiveness in this patient group has not yet been established. Therefore, the aim of this study was to evaluate the cost-utility of CC for the treatment of comorbid MDD in chronically ill patients in the outpatient general hospital setting. The study was conducted from a health care and societal perspective.Patients and methods: In this randomized controlled trial, 81 patients with moderate-to-severe MDD were included; 42 were randomly assigned to the CC group and 39 to the care as usual (CAU group. We applied the TiC-P, short-form Health-Related Quality of Life questionnaire, and EuroQol EQ-5D 3 level version, measuring the use of health care, informal care, and household work, respectively, at baseline and at 3, 6, 9, and 12 months follow-up.Results: The mean annual direct medical costs in the CC group were €6,718 (95% confidence interval [CI]: 3,541 to 10,680 compared to €4,582 (95% CI: 2,782 to 6,740 in the CAU group. The average quality-adjusted life years (QALYs gained were 0.07 higher

  15. Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study.

    Science.gov (United States)

    Blom, Jeanet; den Elzen, Wendy; van Houwelingen, Anne H; Heijmans, Margot; Stijnen, Theo; Van den Hout, Wilbert; Gussekloo, Jacobijn

    2016-01-01

    older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. cluster randomised trial. all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. Netherlands trial register, NTR1946. of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.

  16. Implementation of integration strategies between primary care units and a regional general hospital in Brazil to update and connect health care professionals: a quasi-experimental study protocol.

    Science.gov (United States)

    Bracco, Mario Maia; Mafra, Ana Carolina Cintra Nunes; Abdo, Alexandre Hannud; Colugnati, Fernando Antonio Basile; Dalla, Marcello Dala Bernardina; Demarzo, Marcelo Marcos Piva; Abrahamsohn, Ises; Rodrigues, Aline Pacífico; Delgado, Ana Violeta Ferreira de Almeida; Dos Prazeres, Glauber Alves; Teixeira, José Carlos; Possa, Silvio

    2016-08-12

    Better communication among field health care teams and points of care, together with investments focused on improving teamwork, individual management, and clinical skills, are strategies for achieving better outcomes in patient-oriented care. This research aims to implement and evaluate interventions focused on improving communication and knowledge among health teams based on points of care in a regional public health outreach network, assessing the following hypotheses: 1) A better-working communication process between hospitals and primary health care providers can improve the sharing of information on patients as well as patients' outcomes. 2) A skill-upgrading education tool offered to health providers at their work sites can improve patients' care and outcomes. A quasi-experimental study protocol with a mixed-methods approach (quantitative and qualitative) was developed to evaluate communication tools for health care professionals based in primary care units and in a general hospital in the southern region of São Paulo City, Brazil. The usefulness and implementation processes of the integration strategies will be evaluated, considering: 1) An Internet-based communication platform that facilitates continuity and integrality of care to patients, and 2) A tailored updating distance-learning course on ambulatory care sensitive conditions for clinical skills improvements. The observational study will evaluate a non-randomized cohort of adult patients, with historical controls. Hospitalized patients diagnosed with an ambulatory care sensitive condition will be selected and followed for 1 year after hospital discharge. Data will be collected using validated questionnaires and from patients' medical records. Health care professionals will be evaluated related to their use of education and communication tools and their demographic and psychological profiles. The primary outcome measured will be the patients' 30-day hospital readmission rates. A sample size of 560

  17. Application Anti Microbial Activity Test and Direct Inoculation of Urinary Specimen Test to Increase the Quality of Results and Decrease the Production Cost in Clinical Microbiology Laboratory, Sanglah General Hospital Hospital, Bali-Indonesia

    Directory of Open Access Journals (Sweden)

    Nyoman Sri-Budayanti

    2012-05-01

    Full Text Available Objective: Urinary tract infection (UTI is the most common bacterial infection in general practice and in hospitals. Fast and accurate urine culture and sensitivity test are needed for adequate therapy. Anti Microbial Activity test (AMA test that is used to detect the presence of antibiotics in urine specimens is not commonly used in clinical microbiology laboratories. Some laboratories are still using indirect inoculation technique using enriched media before inoculating onto the agar media. The aim of this research is to compare results of urinary examination of direct inoculation technique with AMA test with indirect inoculation technique without AMA test.Methods: A number of 210 urine specimens were collected in Clinical Microbiology Laboratory at Sanglah General Hospital within a time period between 16 June until 16 July 2009.Results: Antibiotics were detected in 40% of the urinary specimens; whereas 48.1% showed no evidence of UTI, that is negative AMA test and sterile urinary culture or colony growth < 105 CFU/ml. Only 11.9% of the specimens indicates urinary tract infections. The examination can be completed within 2-3 days which is shorter than indirect inoculation test which require 5-7 days. Direct inoculation technique can reduce the cost of production three-fold the costs require for an indirect inoculation test.Conclusions: Application of AMA test and direct inoculation technique can give results more rapidly, reliable and useful for clinicians. This also decrease the laboratory’s cost of production.

  18. Declarativity and efficiency in providing services of general economic interest. Empirical study regarding the relation between heating costs and budget constraints

    Directory of Open Access Journals (Sweden)

    Dumitru Miron

    2013-06-01

    Full Text Available Defined by each country separately, according to real options, circumstances and traditions, the services of general economic interest have an objective purpose in ensuring protection and security for population. The services of general economic interest involve both public and economic services and show characteristics of both fields, reflecting the capabilities of communities to organize, regulate and provide them. Considering the accessibility to the essential service of general economic interest of providing household heating, as an undeniable condition of consumer protection, an analysis has been made in this field, with reference to the concrete manner of providing these services. The goal of this endeavor was to emphasize the actual conditionalities induced by the budget constraints of households while ensuring the universality of the access to the essential heating service. The empirical study is based on a survey of 55 households in sector 2 of Bucharest that have access to gas heating systems, while they have different revenues and equipments. The processing of the gathered data allowed the procurement of certain indicators that explain how household revenues determine the access to the heating services and how the deficiencies of the insurance system of these services deepen the social polarization and increase the weightings of those living at the limit of subsistence.

  19. 7 CFR 249.12 - SFMNP costs.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false SFMNP costs. 249.12 Section 249.12 Agriculture....12 SFMNP costs. (a) General. (1) Composition of allowable costs. In general, a cost item will be... administration and operation of the SFMNP. Allowable SFMNP costs may be classified as follows: (i) Food costs and...

  20. Cost-effectiveness of preventing dental caries and full mouth dental reconstructions among Alaska Native children in the Yukon–Kuskokwim delta region of Alaska

    Science.gov (United States)

    Atkins, Charisma Y.; Thomas, Timothy K.; Lenaker, Dane; Day, Gretchen M.; Hennessy, Thomas W.; Meltzer, Martin I.

    2016-01-01

    Objective We conducted a cost-effectiveness analysis of five specific dental interventions to help guide resource allocation. Methods We developed a spreadsheet-based tool, from the healthcare payer perspective, to evaluate the cost effectiveness of specific dental interventions that are currently used among Alaska Native children (6-60 months). Interventions included: water fluoridation, dental sealants, fluoride varnish, tooth brushing with fluoride toothpaste, and conducting initial dental exams on children caries treatments completed by a dental provider in the dental chair, while 161 children received FMDRs completed by a dental surgeon in an operating room. The average cost of treating dental caries in the dental chair was $1,467 (~258,000 per year); while the cost of treating FMDRs was $9,349 (~1.5 million per year). All interventions were shown to prevent caries and FMDRs; however tooth brushing prevented the greatest number of caries at minimum and maximum effectiveness with 1,433 and 1,910, respectively. Tooth brushing also prevented the greatest number of FMDRs (159 and 211) at minimum and maximum effectiveness. Conclusions All of the dental interventions evaluated were shown to produce cost savings. However, the level of that cost saving is dependent on the intervention chosen. PMID:26990678

  1. Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry.

    Science.gov (United States)

    Kent, C D; Mashour, G A; Metzger, N A; Posner, K L; Domino, K B

    2013-03-01

    Anaesthetic awareness is a recognized complication of general anaesthesia (GA) and is associated with post-traumatic stress disorder (PTSD). Although complete amnesia for intraprocedural events during sedation and regional anaesthesia (RA) may occur, explicit recall is expected by anaesthesia providers. Consequently, the possibility that there could be psychological consequences associated with unexpected explicit recall of events during sedation and RA has not been investigated. This study investigated the psychological sequelae of unexpected explicit recall of events during sedation/RA that was reported to the Anesthesia Awareness Registry. The Registry recruited subjects who self-identified as having had anaesthetic awareness. Inclusion criteria were a patient-reported awareness experience in 1990 or later and availability of medical records. The sensations experienced by the subjects during their procedure and the acute and persistent psychological sequelae attributed to this explicit recall were assessed for patients receiving sedation/RA and those receiving GA. Among the patients fulfilling the inclusion criteria, medical record review identified 27 sedation/RA and 50 GA cases. Most patients experienced distress (78% of sedation/RA vs 94% of GA). Approximately 40% of patients with sedation/RA had persistent psychological sequelae, similar to GA patients. Some sedation/RA patients reported an adverse impact on their job performance (15%), family relationships (11%), and friendships (11%), and 15% reported being diagnosed with PTSD. Patients who self-reported to the Registry unexpected explicit recall of events during sedation/RA experienced distress and persistent psychological sequelae comparable with those who had reported anaesthetic awareness during GA. Further study is warranted to determine if patients reporting distress with explicit recall after sedation/RA require psychiatric follow-up.

  2. Approximate Cores of a General Class of Economies. Part II. Set-Up Costs and Firm Formation in Coalition Production Economies,

    Science.gov (United States)

    1982-02-01

    r AAI1Z 608 YALE UNIV NEW HAVEN CT C OWLES FOUNDATION FOR RESEARC --ETC F/G 513 APPROXIMATE CORES 6F A GENERAL CLASS OF ECONOMIES. PART It. SET--ETC(U...theoretic models of the economy in strategic form are institutional. Markets and firms and even money are assumed to exist. Cooperative game theory can be...groups. Alternatively we can define firms and firms- in-being, specify the manner of trade in the markets , define what is meant by entry and exit and

  3. A worldwide review of the cost of nuclear power

    International Nuclear Information System (INIS)

    Lecomte, M.; Mario, N.; Vignon, D.

    2014-01-01

    The 'true cost' of nuclear energy is a subject of great controversy, especially when considering capital costs of recent projects which opponents to this technology claim to be out of control. In order to provide an objective assessment of nuclear competitiveness, a systematic review of nuclear costs as estimated by stakeholders on a worldwide basis (parliamentary commissions, general accounting offices, academics from universities, non-governmental organizations [either promoting nuclear, or nonnuclear energy], utilities and vendors) was done. Based on these data, levelised costs of electricity (LCOE) were calculated, for different technologies and different regional areas. A breakdown between the key factors (pre-construction and owner costs, Capex, Opex, spent fuel management, dismantling and decommissioning) was provided. The study generally concludes that nuclear energy remains competitive, although costs of advanced technologies soared compared to Gen II. It also demonstrates the benefit of steady and ongoing nuclear programs compared to construction of single projects from time to time. (authors)

  4. [Impact of the chemotherapy protocols for metastatic breast cancer on the treatment cost and the survival time of 371 patients treated in three hospitals of the Rhone-Alpes region].

    Science.gov (United States)

    Paviot, B Trombert; Bachelot, T; Clavreul, G; Jacquin, J-P; Mille, D; Rodrigues, J-M

    2009-10-01

    The chemotherapy of the metastatic breast cancer is characterized by the diversity of the treatment protocols and the utilisation of new expensive molecules posing the double problem of outcomes for the patients and financial effects for the hospitals. This survey describes the different chemotherapy treatments prescribed in the metastatic breast cancer and the direct costs supported by the hospitals according to the patient survival time. A cohort of 371 patients treated for a metastatic breast cancer was followed in three hospitals of the Rhone-Alpes region between 2001 and 2006. The detail of their different antineoplasic treatments, as well as the purchase cost of the drugs and their cost of hospital administration, the cost of the other hospital stays are presented in relation with the survival. The median survival time (35,8 months; CI 95%: [31.7-39.1]) since the first metastasis does not differ significantly according to the hospital. Ninety-three different chemotherapy protocols are observed combining from one to five molecules. Thirty-two different molecules are identified. In first line treatment, there is a significant difference in the use of the new molecules according to hospital (Chi(2) test; P cost of a chemotherapy treatment is 3,919 euro (+/- 8,069 euro), the higher cost is observed for trastuzumab (23,443 euro). The average time period before the beginning of a new chemotherapy line is 212 days (+/- 237 days) and the mean cost of hospital stay during this period is 3,903 euro (+/- 4,097 euro). If no impact of the chemotherapy treatment strategy is observed on the survival time of the patient, it is the opposite for the hospital treatment cost. These results are asking for a better control system of the authorization procedure of new molecules marketing and the harmonization of the practices.

  5. Influence of Controlling in the Generation of information for the process of Management of Costs Of forniture industries of Francisco Beltrão – PR Region

    Directory of Open Access Journals (Sweden)

    Osmarina Pedro Garcia Garcia

    2016-06-01

    Full Text Available The emergence of the Controller is connected to the need to improve company management. One way that the controller finds to ensure the continuity of the company is reducing costs and expenses, in order to make the product more competitive to their competitors. To do this, managers now have the controller as an important tool to aid in decision making. This study demonstrates some benefits of controlling; in order to reach this objective a descriptive, qualitative and quantitative survey was made in ten small and medium-sized furniture industries. The main goal of the research is to show the influence of controlling in generating information for the process of cost management of furniture industry in Francisco Beltrão, a city in the state of Paraná, Brazil. The study showed that the controlling influences in reducing costs through reliable information, generated by agile tools, compiled by the controllers and forwarded to managers, assists decision making.

  6. Nuclear power costs in the build, operate, transfer approach

    International Nuclear Information System (INIS)

    Aybers, M.N.; Sahin, B.

    1990-01-01

    The costs of nuclear power are discussed with special reference to the economic problems faced by developing countries, and the relative merit of a new accounting approach, viz., the build, operate, transfer contract model, which was proposed in Turkey for the Akkuyu nuclear power project, is illustrated. In this context, the general methodology of calculating nuclear power costs is summarized and a capital cost analysis for a 986 MW pressurized water reactor plant is given in terms of constant monetary units for the above contract model and the turnkey contract model. Adjustment of the costs taking into account regional conditions such as inflation and higher interest rates is also indicated. (orig.) [de

  7. [Physician's anxiety and physician's elegance. Problems in dealing with cost reduction, education of general practitioners and optimal size of practice networks in a cross-national comparison].

    Science.gov (United States)

    Behrens, J

    2000-03-01

    The key reason for physicians networking in managed care is to get a better coping with uncertainty on action (treatment) decisions. The second reason for networking in managed care are financial benefits grounds. But this reason is very ambivalent. Three different action problems (role conflicts) in managed care network are to solved, which was also in single practices. In the lecture the decision strategies and decision resources has been compared. Observations are done using expert interviews, patient interviews and analysis of documents in USA, Germany and Switzerland. The first problem is the choosing of a cost reduction strategy which is not reducing the effectiveness. Such "ugly" solution strategies like exclusion of "expensive" patients and a rationing of necessary medical services in a kind of McDonalds network of physicians will fail the target. The optimost way is a saving of all unnecessary medical even injourious performances. The chosen cost reduction strategy is not real visible from outside but in fact limited cognizable and controllable. Evidence based health care can be a resource of treatment decisions and could train such decisions but it will not substitute these decisions. The second problem is the making of real family practitioners as gatekeepers. Knowledge about the care system is still not making a real family practitioner, even if this is the minimum condition of their work. Also contractual relationships between insurance and doctor as a gatekeeper or financial incentives for patients are still making not a real family practitioner as a gatekpeeper. Only throughout the trust of patients supported by second opinions is making the real family practitioner as a gatekeeper. "Doctor hopping" could be the reaction by scarcity of trustworthy family practitioners as gatekeepers. The third problem is the choosing of the optimal scale of a network due to the very different optimal size of networks regarding the requirement of risk spreeds, of the

  8. An alternative rule for determining demand and energy supply based in marginal cost optimization from interconnected hydrothermal systems, focalizing the individualized plants, applied to the interconnected system from South and Southeast regions of Brazil

    International Nuclear Information System (INIS)

    Souza Bond, P. de; Soares Filho, S.

    1989-01-01

    A methodology for determining optimal strategies of energy supply in the interconnected system from South and Southeast regions of Brazil is presented. The problem was modelled, having as principle the minimization of operation pluri annual cost. The dynamic restrictions of energy and peak flow, the dynamic configuration of hydrothermal park and the hydraulic operation restrictions are also considered. (C.G.C.). 7 refs, 3 tabs

  9. An analysis of electric utility embedded power supply costs

    International Nuclear Information System (INIS)

    Kahal, M.; Brown, D.

    1998-01-01

    There is little doubt that for the vast majority of electric utilities the embedded costs of power supply exceed market prices, giving rise to the stranded cost problem. Beyond that simple generalization, there are a number of crucial questions, which this study attempts to answer. What are the regional patterns of embedded cost differences? To what extent is the cost problem attributable to nuclear power? How does the cost of purchased power compare to the cost of utility self-generation? What is the breakdown of utility embedded generation costs between operating costs - which are potentially avoidable--and ownership costs, which by definition are ''sunk'' and therefore not avoidable? How will embedded generation costs and market prices compare over time? These are the crucial questions for states as they address retail-restructuring proposal. This study presents an analysis of generation costs, which addresses these key questions. A computerized costing model was developed and applied using FERC Form 1 data for 1995. The model analyzed embedded power supply costs (i.e.; self-generation plus purchased power) for two groups of investor-owned utilities, 49 non-nuclear vs. 63 nuclear. These two subsamples represent substantially the entire US investor-owned electric utility industry. For each utility, embedded cost is estimated both at busbar and at meter

  10. Challenges for landslide hazard and risk management in ‘low-risk’ regions, Czech Republic—landslide occurrences and related costs (IPL project no. 197)

    Czech Academy of Sciences Publication Activity Database

    Klimeš, Jan; Stemberk, Jakub; Blahůt, Jan; Krejčí, V.; Krejčí, O.; Hartvich, Filip; Kycl, P.

    2017-01-01

    Roč. 14, č. 2 (2017), s. 771-780 ISSN 1612-510X R&D Projects: GA MŠk(CZ) LG15007 Institutional support: RVO:67985891 Keywords : landslide inventory * ICL/IPL activities * landslide cost * landslide risk * fatal landslides * public awareness Subject RIV: DE - Earth Magnetism, Geodesy, Geography OBOR OECD: Physical geography Impact factor: 3.657, year: 2016

  11. Information on the Schacht Asse II. Expensive home country. What costs the Asse facility? What is the value of region? Key aspect money

    International Nuclear Information System (INIS)

    2015-01-01

    The information brochure on Asse II includes the following contributions: The picture of the blind shaft 3 and what does it mean? What costs the Asse facility? Expensive home country. The history of Asse II shows that safety has to stand before economic interests. The Asse legislation of 203 opens new paths for the waste retrieval.

  12. Investigation of Truck Size and Weight Limits - Technical Supplement. Vol. 7. Carrier, Market and Regional Cost and Energy Tradeoffs (pt. 1)

    Science.gov (United States)

    1982-01-01

    This study applied a systematic investigation of the range of benefits and costs to the U.S. economy and society as a whole, as well as to individual interest groups, resulting from a set of alternative changes to current Federal limits on truck size...

  13. Energy efficieny in existing domestic buildings: Technologies, potential, cost and economic efficiency. General report; Energieeffizienz im Wohngebaeudebestand - Techniken, Potenziale, Kosten und Wirtschaftlichkeit. Querschnittsbericht

    Energy Technology Data Exchange (ETDEWEB)

    Loga, T.; Diefenbach, N.; Enseling, A.; Hacke, U.; Born, R.; Knissel, J.; Hinz, E. (comps.)

    2007-11-22

    The study outlines the considerable dynamics of technological development. Among others, the need for accelerating the market penetration of innovative measures is discussed. There are great discrepancies in the practical implementation of different measures, and it is shown that so-called low-investive measures can make a significant contribution to energy conservation. Implementation of complex measures also shows that the results achieved are strongly dependent on the energy savings goals on the one hand and on the regional or local housing situation and the resulting price levels on the other hand. This stresses the influence of the design of boundary conditions, and the question that comes up is the function of funding policy. The housing industry will have to intensify its energetic portfolio management during the next few years to cope with the new challenges, and the consumer behaviour has great influence. Here, too, efficient behaviour has considerable energy saving potential. The next few years will show if and inhowfar measures for higher transparency will have an effect. (orig.)

  14. The Ethnic Composition of Rural Youth in the United States: General Characteristics and Regional Comparisons. Information Report No. 73-3.

    Science.gov (United States)

    Jimenez, Luis A.

    Population characteristics of rural youth (persons under 25 years of age) living in the rural areas of the four national regions of North Central, Northeast, West, and South are presented. Emphasis is placed on describing the racial and ethnic variations shown by the target population; focus is on the regional distribution of ethnic minority…

  15. Ventilation cost and air cleaning

    Science.gov (United States)

    Goodfellow, H. D.

    The components associated with the costs of the purchase of pollution control equipment are discussed. These include the capital cost to purchase the equipment and installation, and the costs incurred to operate the control device on an annual basis. Although the capital costs can represent a significant outlay of money, typically these costs are spread out over the life of the equipment. In general, this amortized cost is combined with the operating cost and is referred to as an 'annualized cost'. The annualized cost is a commonly used indicator to demonstrate the actual year to year cost that the equipment and operation will represent. Values and methods used to estimate costs, typical cost indicators, and sources of computerized costing models are presented. A comparison of the capital cost expenditure required for a model case (a cement kiln operation), using three control device alternatives is made.

  16. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Davidson, Andrew J; Disma, Nicola; De Graaff, Jurgen C; Withington, Davinia E; Dorris, Liam; Bell, Graham; Stargatt, Robyn; Bellinger, David C; Schuster, Tibor; Arnup, Sarah J; Hardy, Pollyanna; Hunt, Rodney W; Takagi, Michael J; Giribaldi, Gaia; Hartmann, Penelope L; Salvo, Ida; Morton, Neil S; Von Ungern Sternberg, Britta S; Locatelli, Bruno Guido; Wilton, Niall; Lynn, Anne; Thomas, Joss J; Polaner, David; Bagshaw, Oliver; Szmuk, Peter; Absalom, Anthony R; Frawley, Geoff; Berde, Charles; Ormond, Gillian D; Marmor, Jacki; Mccann, Mary Ellen

    2016-01-01

    Background Preclinical data suggest that general anaesthetics affect brain development. There is mixed evidence from cohort studies that young children exposed to anaesthesia can have an increased risk of poor neurodevelopmental outcome. We aimed to establish whether general anaesthesia in infancy

  17. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS) : an international multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Davidson, Andrew J; Disma, Nicola; de Graaff, Jurgen C; Withington, Davinia E; Dorris, Liam; Bell, Graham; Stargatt, Robyn; Bellinger, David C; Schuster, Tibor; Arnup, Sarah J; Hardy, Pollyanna; Hunt, Rodney W; Takagi, Michael J; Giribaldi, Gaia; Hartmann, Penelope L; Salvo, Ida; Morton, Neil S; von Ungern Sternberg, Britta S; Locatelli, Bruno Guido; Wilton, Niall; Lynn, Anne; Thomas, Joss J; Polaner, David; Bagshaw, Oliver; Szmuk, Peter; Absalom, Anthony R; Frawley, Geoff; Berde, Charles; Ormond, Gillian D; Marmor, Jacki; McCann, Mary Ellen

    BACKGROUND: Preclinical data suggest that general anaesthetics affect brain development. There is mixed evidence from cohort studies that young children exposed to anaesthesia can have an increased risk of poor neurodevelopmental outcome. We aimed to establish whether general anaesthesia in infancy

  18. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS) : an international multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Davidson, Andrew J.; Disma, Nicola; de Graaff, Jurgen C.; Withington, Davinia E.; Dorris, Liam; Bell, Graham; Stargatt, Robyn; Bellinger, David C.; Schuster, Tibor; Arnup, Sarah J.; Hardy, Pollyanna; Hunt, Rodney W.; Takagi, Michael J.; Giribaldi, Gaia; Hartmann, Penelope L.; Salvo, Ida; Morton, Neil S.; Sternberg, Britta S. von Ungern; Locatelli, Bruno Guido; Wilton, Niall; Lynn, Anne; Thomas, Joss J.; Polaner, David; Bagshaw, Oliver; Szmuk, Peter; Absalom, Anthony R.; Frawley, Geoff; Berde, Charles; Ormond, Gillian D.; Marmor, Jacki; McCann, Mary Ellen

    2016-01-01

    Background Preclinical data suggest that general anaesthetics affect brain development. There is mixed evidence from cohort studies that young children exposed to anaesthesia can have an increased risk of poor neurodevelopmental outcome. We aimed to establish whether general anaesthesia in infancy

  19. Costs of employee turnover

    Directory of Open Access Journals (Sweden)

    Jiří Duda

    2013-01-01

    Full Text Available The aim of this paper is to establish a general methodology for calculating the costs incurred by employee turnover. This paper deals with identification of costs incurred by the departure of an employee, and does not deal with the cost of recruitment of a new employee. Economic calculations are adjusted to the tax policy in the Czech Republic. The costs of employee turnover (according to Bliss, 2012 include the costs of substitution of the unoccupied position, costs of conducting the exit interview and termination of the contract. The cost of an executive’s time to understand the causes of leaving and costs of the leaving employee’s training were also determined. Important factors in the costs of employee turnover also include the loss of knowledge and possibly also a loss of customers. Costs of lost employee and department productiveness represent an important part of the costs of employee turnover, as well. For all of these costs there have been proposed general calculations formulas.

  20. Generalized Superconductivity. Generalized Levitation

    International Nuclear Information System (INIS)

    Ciobanu, B.; Agop, M.

    2004-01-01

    In the recent papers, the gravitational superconductivity is described. We introduce the concept of generalized superconductivity observing that any nongeodesic motion and, in particular, the motion in an electromagnetic field, can be transformed in a geodesic motion by a suitable choice of the connection. In the present paper, the gravitoelectromagnetic London equations have been obtained from the generalized Helmholtz vortex theorem using the generalized local equivalence principle. In this context, the gravitoelectromagnetic Meissner effect and, implicitly, the gravitoelectromagnetic levitation are given. (authors)

  1. Green-E general program and public information support program report, August 1, 1999 - September 30, 2000

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Kirk

    2000-09-30

    Green-E Program support from the Dept. of Energy augmented the costs of implementing the objectives of the Green-E Renewable Electricity Project; general program implementation; regional adaptation; developing strategic partnerships; and public information/education/outreach.

  2. AKUNTANSI REVALUASI TANAH DAN BANGUNAN DALAM PELEPASAN ASET TETAP PADA PERUM PERUMNAS REGIONAL VII MAKASSAR (STUDI KOMPARASI HISTORICAL COST VS FAIR VALUE)

    OpenAIRE

    MUSLIEM RL, MUSTAFA

    2013-01-01

    2013 Secara umum, akuntansi konvensional, laporan keuangan disajikan berdasarkan historical cost, yang mengasumsikan bahwa harga (unit moneter) adalah stabil. Biasa akuntansi tidak mengakui perubahan tingkat harga umum atau perubahan tertentu tingkat harga. Akibatnya, jika ada perubahan seperti daya beli, sejarah laporan keuangan adalah relevan secara ekonomi, karena tidak mencerminkan benar nilai pasar. Harus ada model tunggal untuk mengukur instrumen keuangan. model ini mengacu pada fair...

  3. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke

    2015-01-01

    . The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...

  4. [Applications and spproved projects of general program, young scientist fund and fund for less developed region of national natural science funds in discipline of Chinese materia medica, NSFC in 2011].

    Science.gov (United States)

    Han, Liwei; Wang, Yueyun; He, Wenbin; Zhang, Junjie; Bi, Minggang; Shang, Hongcai; Shang, Deyang; Wang, Chang'en

    2012-03-01

    The applications accepted and approved by general program, young scientist fund and fund for less developed region of national natural science funds in the discipline of Chinese materia medica, NSFC in 2011 have been introduced. The character and problems in these applications have been analyzed to give a reference to the scientists in the field of Chinese material medica.

  5. Industrial effluent costs in some Spanish regions and other parts of the EU. Canons and taxes of water treatment; El coste del vertido industrial en varias comunidades autonomas espanolas y en algunos territorios europeos. Los canones y tasas de depuracion

    Energy Technology Data Exchange (ETDEWEB)

    Grau Rahola, J.; Munoz Requena, A.; Ruaix Prat, T.

    2009-07-01

    In this article, the different systems existing in the Spanish regions for paying all the expense related to industrial effluents are examined and compared with the ones in use in other parts of the EU. Also, the degree of fulfillment of the economic objectives of the Water Framework Directives is determined. The findings are quite clear that there is a comparative disadvantage in the sense that some of the regions have not even regulated and instrument to ensure the principle of Who pollutes, pays, there is a widespread unequal treatment for the same type of effluent within Spain and there is clear evidence of a transfer of resources from the industrial use to the domestic one. (Author)

  6. Nuclear power regional analysis

    International Nuclear Information System (INIS)

    Parera, María Delia

    2011-01-01

    In this study, a regional analysis of the Argentine electricity market was carried out considering the effects of regional cooperation, national and international interconnections; additionally, the possibilities of insertion of new nuclear power plants in different regions were evaluated, indicating the most suitable areas for these facilities to increase the penetration of nuclear energy in national energy matrix. The interconnection of electricity markets and natural gas due to the linkage between both energy forms was also studied. With this purpose, MESSAGE program was used (Model for Energy Supply Strategy Alternatives and their General Environmental Impacts), promoted by the International Atomic Energy Agency (IAEA). This model performs a country-level economic optimization, resulting in the minimum cost for the modelling system. Regionalization executed by the Wholesale Electricity Market Management Company (CAMMESA, by its Spanish acronym) that divides the country into eight regions. The characteristics and the needs of each region, their respective demands and supplies of electricity and natural gas, as well as existing and planned interconnections, consisting of power lines and pipelines were taken into account. According to the results obtained through the model, nuclear is a competitive option. (author) [es

  7. The cost of installing central heating. Comparison of Norway and Sweden. Final version; Kostnader ved installasjon av vannbaaren varme. Sammenlikning av Norge og Sverige. Endelig versjon

    Energy Technology Data Exchange (ETDEWEB)

    Haarberg, Karl Johan; Elnan, Kaare; Essen, Jan von; Hovden, Agnete; Ekvall, Thomas; Melbaeck, Johan

    2010-10-22

    The objective of the cost study is to examine costs and cost differences associated with the installation of various technical solutions for water heating in various buildings in Norway and Sweden - regionally and nationally. In addition, the cost study intended to point out any barriers to the increased prevalence of central heating, as well as proposals for measures to remove such. Finally, the cost study in general and in particular barriers placed in a larger environment and climate perspective. (AG)

  8. Irradiation of members of the general public from radioactive caesium following the Chernobyl reactor accident. Field studies in a highly contaminated area in the Bryansk region, Russia

    Energy Technology Data Exchange (ETDEWEB)

    Thornberg, C

    2000-11-01

    From 1990 to 1999, estimations of the effective dose from external as well as internal irradiation from {sup 137}Cs and {sup 134}Cs were carried out for inhabitants in rural villages in the Bryansk region, Russia, highly contaminated due to the Chernobyl accident in 1986. The villages were situated about 180 km from the Chernobyl power plant and the deposition of {sup 137}Cs was in the range 0.9-2.7 MBq/m{sup 2}. Yearly expeditions were conducted in autumn by members of the Departments of Radiation Physics in Malmoe and Goeteborg, Institute of Radiation Hygiene, St. Petersburg and the the first 5 years also by the Norwegian Radiation Protection Authority. The dose levels and their change in time were estimated for various groups of the general public. The body burden of {sup 134,137}Cs and hence, the effective dose, was estimated from measurements of the urinary concentration of cesium radionuclides, together with direct measurements of the body content using a portable detector. The effective dose from external irradiation was estimated from measurements with thermoluminescent dosemeters worn by the participants during one month each year. In a special case study, the changes in biokinetics of {sup 137}Cs during pregnancy was investigated in a woman with an unintended intake of {sup 137}Cs via mushrooms from a highly contaminated forest in the area. During pregnancy there is an increased excretion of cesium resulting in a biological half-time of cesium which was 54% of the half-time before pregnancy. The ratio of the {sup 137}Cs concentration in breast milk (Bq/l) to that in the mother's body (Bq/kg) was 15% one month after the child was born. The body burden of {sup 137}Cs in the Russian individuals calculated from the concentration of {sup 137}Cs in urine showed a good agreement with the body burden estimated from in vivo measurements in the same individuals. Normalisation of the cesium concentration in the urine samples by the use of potassium or

  9. Irradiation of members of the general public from radioactive caesium following the Chernobyl reactor accident. Field studies in a highly contaminated area in the Bryansk region, Russia

    International Nuclear Information System (INIS)

    Thornberg, C.

    2000-11-01

    From 1990 to 1999, estimations of the effective dose from external as well as internal irradiation from 137 Cs and 134 Cs were carried out for inhabitants in rural villages in the Bryansk region, Russia, highly contaminated due to the Chernobyl accident in 1986. The villages were situated about 180 km from the Chernobyl power plant and the deposition of 137 Cs was in the range 0.9-2.7 MBq/m 2 . Yearly expeditions were conducted in autumn by members of the Departments of Radiation Physics in Malmoe and Goeteborg, Institute of Radiation Hygiene, St. Petersburg and the the first 5 years also by the Norwegian Radiation Protection Authority. The dose levels and their change in time were estimated for various groups of the general public. The body burden of 134,137 Cs and hence, the effective dose, was estimated from measurements of the urinary concentration of cesium radionuclides, together with direct measurements of the body content using a portable detector. The effective dose from external irradiation was estimated from measurements with thermoluminescent dosemeters worn by the participants during one month each year. In a special case study, the changes in biokinetics of 137 Cs during pregnancy was investigated in a woman with an unintended intake of 137 Cs via mushrooms from a highly contaminated forest in the area. During pregnancy there is an increased excretion of cesium resulting in a biological half-time of cesium which was 54% of the half-time before pregnancy. The ratio of the 137 Cs concentration in breast milk (Bq/l) to that in the mother's body (Bq/kg) was 15% one month after the child was born. The body burden of 137 Cs in the Russian individuals calculated from the concentration of 137 Cs in urine showed a good agreement with the body burden estimated from in vivo measurements in the same individuals. Normalisation of the cesium concentration in the urine samples by the use of potassium or creatinine excretion was found to introduce systematic

  10. Costly location in Hotelling duopoly

    NARCIS (Netherlands)

    Hinloopen, J.; Martin, S.

    2013-01-01

    We introduce a cost of location into Hotelling’s (1929) spatial duopoly. We derive the general conditions on the cost-of-location function under which a pure strategy price-location Nash equilibrium exists. With linear transportation cost and a suitably specified cost of location that rises toward

  11. Costly location in Hotelling duopoly

    NARCIS (Netherlands)

    Hinloopen, J.; Martin, S.

    We introduce a cost of location into Hotelling's (1929) spatial duopoly model. We derive the general conditions on the cost-of-location function under which a pure strategy price-location Nash equilibrium exists. With linear transportation cost and a suitably specified cost of location that rises

  12. Production cost methods and data

    Science.gov (United States)

    Jeffe, R. E.; Fujita, T.

    1975-01-01

    The general gas cost equation for utility financing is presented. Modifications and assumptions made in order to apply the cost equation to hydrogen production are described. Cost data are given for various methods of hydrogen production. The cost matrix procedure is briefly discussed.

  13. Regionalism, Regionalization and Regional Development

    Directory of Open Access Journals (Sweden)

    Liviu C. Andrei

    2016-03-01

    Full Text Available Sustained development is a concept associating other concepts, in its turn, in the EU practice, e.g. regionalism, regionalizing and afferent policies, here including structural policies. This below text, dedicated to integration concepts, will limit on the other hand to regionalizing, otherwise an aspect typical to Europe and to the EU. On the other hand, two aspects come up to strengthen this field of ideas, i.e. the region (al-regionalism-(regional development triplet has either its own history or precise individual outline of terms.

  14. The electric vehicles as a mean to reduce CO2 emissions and energy costs in isolated regions. The São Miguel (Azores) case study

    International Nuclear Information System (INIS)

    Camus, Cristina; Farias, Tiago

    2012-01-01

    Most of small islands around the world today, are dependent on imported fossil fuels for the majority of their energy needs especially for transport activities and electricity production. The use of locally renewable energy resources and the implementation of energy efficiency measures could make a significant contribution to their economic development by reducing fossil fuel imports. An electrification of vehicles has been suggested as a way to both reduce pollutant emissions and increase security of supply of the transportation sector by reducing the dependence on oil products imports and facilitate the accommodation of renewable electricity generation, such as wind and, in the case of volcanic islands like São Miguel (Azores) of the geothermal energy whose penetration has been limited by the valley electricity consumption level. In this research, three scenarios of EV penetration were studied and it was verified that, for a 15% LD fleet replacement by EVs with 90% of all energy needs occurring during the night, the accommodation of 10 MW of new geothermal capacity becomes viable. Under this scenario, reductions of 8% in electricity costs, 14% in energy, 23% in fossil fuels use and CO 2 emissions for the transportation and electricity production sectors could be expected. - Highlights: ► EVs impacts on the electric system in energy and power profiles, costs and emissions. ► At least an EV penetration of 15% is needed to allow new geothermal power production. ► Reductions in energy, fossil fuels use and CO 2 emissions of 9%, 16% and 17% respectively. ► Electricity production with more % of renewable technologies reduces unit costs.

  15. Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia.

    Science.gov (United States)

    Curtis, Kate; Lam, Mary; Mitchell, Rebecca; Black, Deborah; Taylor, Colman; Dickson, Cara; Jan, Stephen; Palmer, Cameron S; Langcake, Mary; Myburgh, John

    2014-01-01

    Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. To describe the costs of acute trauma admissions in trauma centres, identify predictors of higher treatment costs and cost variance in New South Wales (NSW), Australia. Data linkage of admitted trauma patient and financial data provided by 12 Level 1 NSW trauma centres for the 08/09 financial year was performed. Demographic, injury details and injury scores were obtained from trauma registries. Individual patient general ledger costs (actual trauma patient costs), Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs (which form the basis of funding) were obtained. The actual costs incurred by the hospital were then compared with the state-wide AR-DRG average costs. Multivariable multiple linear regression was used for identifying predictors of costs. There were 17,522 patients, the average per patient cost was $10,603 and the median was $4628 (interquartile range: $2179-10,148). The actual costs incurred by trauma centres were on average $134 per bed day above AR-DRG costs-determined costs. Falls, road trauma and violence were the highest causes of total cost. Motor cyclists and pedestrians had higher median costs than motor vehicle occupants. As a result of greater numbers, patients with minor injury had comparable total costs with those generated by patients with severe injury. However the median cost of severely injured patients was nearly four times greater. The count of body regions injured, sex, length of stay, serious traumatic brain injury and admission to the Intensive Care Unit were significantly associated with increased costs (p<0.001). This

  16. A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting - rationale, design and baseline characteristics.

    Science.gov (United States)

    Laurence, Caroline; Gialamas, Angela; Yelland, Lisa; Bubner, Tanya; Ryan, Philip; Willson, Kristyn; Glastonbury, Briony; Gill, Janice; Shephard, Mark; Beilby, Justin

    2008-08-06

    Point of care testing (PoCT) may be a useful adjunct in the management of chronic conditions in general practice (GP). The provision of pathology test results at the time of the consultation could lead to enhanced clinical management, better health outcomes, greater convenience and satisfaction for patients and general practitioners (GPs), and savings in costs and time. It could also result in inappropriate testing, increased consultations and poor health outcomes resulting from inaccurate results. Currently there are very few randomised controlled trials (RCTs) in GP that have investigated these aspects of PoCT. The Point of Care Testing in General Practice Trial (PoCT Trial) was an Australian Government funded multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost effectiveness and satisfaction of PoCT in a GP setting.The PoCT Trial covered an 18 month period with the intervention consisting of the use of PoCT for seven tests used in the management of patients with diabetes, hyperlipidaemia and patients on anticoagulant therapy. The primary outcome measure was the proportion of patients within target range, a measure of therapeutic control. In addition, the PoCT Trial investigated the safety of PoCT, impact of PoCT on patient compliance to medication, stakeholder satisfaction, cost effectiveness of PoCT versus laboratory testing, and influence of geographic location. The paper provides an overview of the Trial Design, the rationale for the research methodology chosen and how the Trial was implemented in a GP environment. The evaluation protocol and data collection processes took into account the large number of patients, the broad range of practice types distributed over a large geographic area, and the inclusion of pathology test results from multiple pathology laboratories.The evaluation protocol developed reflects the complexity of the Trial setting, the Trial Design and the approach taken within the funding

  17. A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting – rationale, design and baseline characteristics

    Directory of Open Access Journals (Sweden)

    Glastonbury Briony

    2008-08-01

    Full Text Available Abstract Background Point of care testing (PoCT may be a useful adjunct in the management of chronic conditions in general practice (GP. The provision of pathology test results at the time of the consultation could lead to enhanced clinical management, better health outcomes, greater convenience and satisfaction for patients and general practitioners (GPs, and savings in costs and time. It could also result in inappropriate testing, increased consultations and poor health outcomes resulting from inaccurate results. Currently there are very few randomised controlled trials (RCTs in GP that have investigated these aspects of PoCT. Design/Methods The Point of Care Testing in General Practice Trial (PoCT Trial was an Australian Government funded multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost effectiveness and satisfaction of PoCT in a GP setting. The PoCT Trial covered an 18 month period with the intervention consisting of the use of PoCT for seven tests used in the management of patients with diabetes, hyperlipidaemia and patients on anticoagulant therapy. The primary outcome measure was the proportion of patients within target range, a measure of therapeutic control. In addition, the PoCT Trial investigated the safety of PoCT, impact of PoCT on patient compliance to medication, stakeholder satisfaction, cost effectiveness of PoCT versus laboratory testing, and influence of geographic location. Discussion The paper provides an overview of the Trial Design, the rationale for the research methodology chosen and how the Trial was implemented in a GP environment. The evaluation protocol and data collection processes took into account the large number of patients, the broad range of practice types distributed over a large geographic area, and the inclusion of pathology test results from multiple pathology laboratories. The evaluation protocol developed reflects the complexity of the Trial setting

  18. Integrating Oral Health with Non-Communicable Diseases as an Essential Component of General Health: WHO's Strategic Orientation for the African Region.

    Science.gov (United States)

    Varenne, Benoit

    2015-05-01

    In the context of the emerging recognition of non-communicable diseases (NCDs), it has never been more timely to explore the World Health Organization (WHO) strategic orientations on oral health in the WHO African region and to raise awareness of a turning point in the search for better oral health for everyone. The global initiative against NCDs provides a unique opportunity for the oral health community to develop innovative policies for better recognition of oral health, as well as to directly contribute to the fight against NCDs and their risk factors. The WHO African region has led the way in developing the first regional oral health strategy for the prevention and control of oral diseases integrated with NCDs. The support of the international oral health community in this endeavor is urgently needed for making a success story of this initiative of integrating oral health into NCDs.

  19. CARETS: A prototype regional environmental information system. Volume 6: Cost, accuracy and consistency comparisons of land use maps made from high-altitude aircraft photography and ERTS imagery

    Science.gov (United States)

    Alexander, R. H. (Principal Investigator); Fitzpatrick, K. A.

    1975-01-01

    The author has identified the following significant results. Level 2 land use maps produced at three scales (1:24,000, 1:100,000, and 1:250,000) from high altitude photography were compared with each other and with point data obtained in the field. The same procedures were employed to determine the accuracy of the Level 1 land use maps produced at 1:250,000 from high altitude photography and color composite ERTS imagery. Accuracy of the Level 2 maps was 84.9 percent at 1:24,000, 77.4 percent at 1:100,000 and 73.0 percent at 1:250,000. Accuracy of the Level 1 1:250,000 maps was 76.5 percent for aerial photographs and 69.5 percent for ERTS imagery. The cost of Level 2 land use mapping at 1:24,000 was found to be high ($11.93 per sq km). The cost of mapping at 1:100,000 ($1.75) was about two times as expensive as mapping at 1:250,000 ($.88), and the accuracy increased by only 4.4 percent.

  20. Using Cable Suspended Submersible Pumps to Reduce Production Costs to Increase Ultimate Recovery in the Red Mountain Field of the San Juan Basin Region

    Energy Technology Data Exchange (ETDEWEB)

    Don L. Hanosh

    2006-08-15

    A joint venture between Enerdyne LLC, a small independent oil and gas producer, and Pumping Solutions Inc., developer of a low volume electric submersible pump, suspended from a cable, both based in Albuquerque, New Mexico, has re-established marginal oil production from Red Mountain Oil Field, located in the San Juan Basin, New Mexico by working over 17 existing wells, installing cable suspended submersible pumps ( Phase I ) and operating the oil field for approximately one year ( Phase II ). Upon the completion of Phases I and II ( Budget Period I ), Enerdyne LLC commenced work on Phase III which required additional drilling in an attempt to improve field economics ( Budget Period II ). The project was funded through a cooperative 50% cost sharing agreement between Enerdyne LLC and the National Energy Technology Laboratory (NETL), United States Department of Energy, executed on April 16, 2003. The total estimated cost for the two Budget Periods, of the Agreement, was $1,205,008.00 as detailed in Phase I, II & III Authorization for Expenditures (AFE). This report describes tasks performed and results experienced by Enerdyne LLC during the three phases of the cooperative agreement.

  1. General general game AI

    OpenAIRE

    Togelius, Julian; Yannakakis, Georgios N.; 2016 IEEE Conference on Computational Intelligence and Games (CIG)

    2016-01-01

    Arguably the grand goal of artificial intelligence research is to produce machines with general intelligence: the capacity to solve multiple problems, not just one. Artificial intelligence (AI) has investigated the general intelligence capacity of machines within the domain of games more than any other domain given the ideal properties of games for that purpose: controlled yet interesting and computationally hard problems. This line of research, however, has so far focuse...

  2. Project cost estimation techniques used by most emerging building ...

    African Journals Online (AJOL)

    consisted of five distinct types of contractors, general builders, civil engineers, electricians ... Mmboswobeni Watson Ladzani, Department of Business Management, University of South .... final cost of a proposed project for a given work scope. Thus, by .... Since the test statistic does not exceed the critical region, the null.

  3. Costs associated with wheeling

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    Wheeling costs are incurred by all companies that experience a change in power flows over their transmission lines during a specific transaction, whether or not the lines of that company are part of the contract path. The costs of providing wheeling service differ from one system to another and from one kind of wheeling transaction to another. While most transactions may be completed using existing capacity, others may require an increase in line. Depending on the situation, some cost components may be high, low, negative, or not incurred at all. This article discusses two general categories of costs; transactional and capital. The former are all operation, maintenance and opportunity costs incurred in completing a specific transaction assuming the existence of adequate capacity. Capital costs are the costs of major new equipment purchases and lines necessary to provide any increased level of transmission services

  4. Long-term psychosocial behavioral outcomes in children following anesthesia: A comparison of the effects of general versus regional anesthesia on term infants delivered by elective cesarean section

    Directory of Open Access Journals (Sweden)

    Aouni Alameddine

    2013-01-01

    Full Text Available Background: Data on the effects of general anesthesia on the fetal and neonatal brain are limited. Animal studies demonstrated that anesthetic agents leave their consequences in the form of learning and memory deficits. The effects of propofol on the fetal neurodevelopment are not clear yet. Materials and Methods: This is a telephone-based questionnaire survey that addressed the effect of general anesthesia by propofol during cesarean section at term with no perinatal complications on the psychosocial behavior of children at 8-10 years of age compared with children having same characteristics except for delivery under neuraxial anesthesia using the Pediatric Symptom Checklist as a score. Results: A total of 187 children were born at term between January 1, 2002 and December 31, 2004 with no perinatal distress under induction of general anesthesia by propofol. 66 children (35.3% were lost to follow-up and parents of two children (1.1% refused to participate. A total of 189 children were included in the study: 119 were born by cesarean section under general anesthesia and 70 were born by cesarean section under neuraxial block. The incidence of psychosocial behavior impairment at 8-10 years of age was not found to be affected by the mode of anesthesia during delivery by cesarean section nor by neonatal nor parental characteristics. Conclusion: Exposure to propofol as an induction agent for general anesthesia or cesarean section does not seem to increase the psychosocial behavior disorder development risk at 8-10 years of age.

  5. Sulfur Emissions, Abatement Technologies and Related Costs for Europe in the RAINS Model Database

    OpenAIRE

    Cofala, J.; Syri, S.

    1998-01-01

    This paper describes the part of the Regional Pollution Information and Simulation (RAINS) model dealing with the potential and costs controlling emissions of sulfur dioxide. The paper describes the selected aggregation level of the emission generating activities and reviews the major options for controlling SO2 emissions. An algorithm for estimating emission control costs is presented. The cost calculation distinguishes 'general'(i.e., valid for all countries) and 'country-specific' paramete...

  6. Cost accounting in ECN

    International Nuclear Information System (INIS)

    Wout, E.L.; Bever Donker, J.M. van.

    1979-01-01

    A five year planning is made in which the available money is distributed to the expected programmes. This five year plan is used as basis for working plan and budget for the next year. In the working plan all financial means are divided into kinds of costs, cost centres and cost units. Based on this working plan and the relevant budgets the tariffs are calculated per working centre (cost centre). The tariffs are fixed for a whole year. Up till now these tariffs are also basis for the cost unit accounting at the end of the year together with the results of the time registration. The estimated work shop services for the working centres are included in the tariffs. For the allocation of overhead costs ECN uses dynamic keys. Depreciation costs with respect to instruments, investments etc. are determined per working centre according to a computer programme. The cost unit related costs are charged directly to cost unit. This implies that project related in instruments are looked upon as running costs. In the future we will try to refine the present cost accounting system still further in this way that we will look upon a cost centre as a profit centre. Furthermore we will try to analyse the tariff and calculation deviations and under/over occupation deviations afterwards (post calculation). The information provided to the management knows a hierachic construction: project information to projectleader, programme (compound projects) information to programme coordinator, cost centre summary to department heads, attention area (compound programme) information to programme coordinator and managing director, ECN research (compound attention areas) information to general management, information re kind of costs to relevant persons, f.e. surveys of expenditure for part time personnel to personnel bureau. The information is provided by the department of Finance and Administrative Organisation. The entire scope of cost accounting is the responsibility of the head of the department

  7. 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...

  8. Perception of the nuclear industry by general practitioner in Champagne-Ardennes (France); Perception du nucleaire par le medecin generaliste en region Champagne-Ardenne

    Energy Technology Data Exchange (ETDEWEB)

    Bouet, P; Goasguen, P; Lewicki, M; Petit, J F; Villette, M

    1990-06-01

    In the case of a nuclear accident, the general practitioners should be the relay in the population information. In order to confront their knowledge and sensitivity with the nuclear industry problems, the authors have conducted an inquiry near to 144 general practitioners in Champagne-Ardennes area, in the immediate neighbourhood of nuclear facilities (CHOOZ, Nogent-sur-Seine, Gravelines) or not. Four subjects are studied: -their perception of the nuclear industry in the environment problems - their knowledge in nuclear physics - their knowledge about the nuclear power plant - their attitude in front of a radiation accident. The authors show that their education and knowledges about the nuclear industry is insufficient and propose several solutions in order to cope with these difficulties.

  9. General conclusions arising from a field evaluation of the Agency's RAPAT and WAMAP programmes in the Asia and Pacific region 1984-1993. Special evaluation review

    International Nuclear Information System (INIS)

    Webb, G.A.; Fitch, J.; Cooley, C.; Saire, D.E.; Colombo, P.; Palacios, E.

    1994-01-01

    In support of the assistance provided to the developing Member States of IAEA in the areas of radiation protection and radioactive waste management, two advisory programmes were established by IAEA. The radiation Protection Advisory Teams (RAPATs) in 1984, and the Radioactive Waste Management Programme (WAMAP) in 1987. This report summarizes general achievements, finding, conclusions and recommendations regarding these two programmes in Indonesia, Thailand, Bangladesh, and Philippines

  10. Extent of Integration of Priority Interventions into General Health Systems: A Case Study of Neglected Tropical Diseases Programme in the Western Region of Ghana.

    Science.gov (United States)

    Mensah, Ernest O; Aikins, Moses K; Gyapong, Margaret; Anto, Francis; Bockarie, Moses J; Gyapong, John O

    2016-05-01

    The global health system has a large arsenal of interventions, medical products and technologies to address current global health challenges. However, identifying the most effective and efficient strategies to deliver these resources to where they are most needed has been a challenge. Targeted and integrated interventions have been the main delivery strategies. However, the health system discourse increasingly favours integrated strategies in the context of functionally merging targeted interventions with multifunctional health care delivery systems with a focus on strengthening country health systems to deliver needed interventions. Neglected Tropical Diseases (NTD) have been identified to promote and perpetuate poverty hence there has been global effort to combat these diseases. The Neglected Tropical Diseases Programme (NTDP) in Ghana has a national programme team and office, however, it depends on the multifunctional health delivery system at the regional and district level to implement interventions. The NTDP seeks further health system integration to accelerate achievement of coverage targets. The study estimated the extent of integration of the NTDP at the national, regional and district levels to provide evidence to guide further integration. The research design was a descriptive case study that interviewed key persons involved in the programme at the three levels of the health system as well as extensive document review. Integration was assessed on two planes-across health system functions-stewardship and governance, financing, planning, service delivery, monitoring and evaluation and demand generation; and across three administrative levels of the health system-national, regional and district. A composite measure of integration designated Cumulative Integration Index (CII) with a range of 0.00-1.00 was used to estimate extent of integration at the three levels of the health system. Service delivery was most integrated while financing and planning were

  11. Open-source implementation of an ad-hoc IEEE802.11a/g/p software-defined radio on low-power and low-cost general purpose processors

    Directory of Open Access Journals (Sweden)

    S. Ciccia

    2017-12-01

    Full Text Available This work proposes a low-cost and low-power software-defined radio open-source platform with IEEE 802.11 a/g/p wireless communication capability. A state-of-the-art version of the IEEE 802.11 a/g/p software for GNU Radio (a free and open-source software development framework is available online, but we show here that its computational complexity prevents operations in low-power general purpose processors, even at throughputs below the standard. We therefore propose an evolution of this software that achieves a faster and lighter IEEE 802.11 a/g/p transmitter and receiver, suitable for low-power general purpose processors, for which GNU Radio provides very limited support; we discuss and describe the software radio processing structuring that is necessary to achieve the goal, providing a review of signal processing techniques. In particular, we emphasize the advanced reduced-instruction set (RISC machine (ARM study case, for which we also optimize some of the processing libraries. The presented software will remain open-source.

  12. Break-even price for upstream activities in Brazil: Evaluation of the opportunity cost of oil production delay in a non-mature sedimentary production region

    International Nuclear Information System (INIS)

    Szklo, Alexandre Salem; Machado, Giovani; Carneiro, Jason Thomas Guerreiro

    2008-01-01

    Some Latin American policy-makers and analysts state that it would be better to hold oil reserves in place than to produce and cash it now, given the recent oil prices spikes and the fear related to future oil supply disruptions. This article evaluates the strategy of delaying the start-up of oil production in a discovered field with proved reserves. A Reference Discounted Cash Flow (FCD-R) for a typical 350 million barrel Brazilian oil field was simulated. The study estimated which future oil price may render the project insensitive to a delay of 5, 10, 15 or 20 years in its production beginning. Additionally, the value of the in situ oil stock was calculated, providing the opportunity cost for delaying oil production in a frontier area, such as Brazil. It is an application of the Hotelling Principle. Findings indicate that progressive delays of 5 years in the start-up of operation of a typical oil field reduce its revenues by a factor of 2. A delay of 10 years would be justifiable at international oil prices higher than US $15/bbl. Delays higher than 10 years lead this break-even price to values between US $200 and 350/bbl. (author)

  13. The spatial and temporal `cost' of volcanic eruptions: assessing economic impact, business inoperability, and spatial distribution of risk in the Auckland region, New Zealand

    Science.gov (United States)

    McDonald, Garry W.; Smith, Nicola J.; Kim, Joon-hwan; Cronin, Shane J.; Proctor, Jon N.

    2017-07-01

    Volcanic risk assessment has historically concentrated on quantifying the frequency, magnitude, and potential diversity of physical processes of eruptions and their consequent impacts on life and property. A realistic socio-economic assessment of volcanic impact must however take into account dynamic properties of businesses and extend beyond only measuring direct infrastructure/property loss. The inoperability input-output model, heralded as one of the 10 most important accomplishments in risk analysis over the last 30 years (Kujawaski Syst Eng. 9:281-295, 2006), has become prominent over the last decade in the economic impact assessment of business disruptions. We develop a dynamic inoperability input-output model to assess the economic impacts of a hypothetical volcanic event occurring at each of 7270 unique spatial locations throughout the Auckland Volcanic Field, New Zealand. This field of at least 53 volcanoes underlies the country's largest urban area, the Auckland region, which is home to 1.4 million people and responsible for 35.3% (NZ201481.2 billion) of the nation's GDP (Statistics New Zealand 2015). We apply volcanic event characteristics for a small-medium-scale volcanic eruption scenario and assess the economic impacts of an `average' eruption in the Auckland region. Economic losses are quantified both with, and without, business mitigation and intervention responses in place. We combine this information with a recent spatial hazard probability map (Bebbington and Cronin Bull Volcanol. 73(1):55-72, 2011) to produce novel spatial economic activity `at risk' maps. Our approach demonstrates how business inoperability losses sit alongside potential life and property damage assessment in enhancing our understanding of volcanic risk mitigation.

  14. Logistics costs of the enterprise

    Directory of Open Access Journals (Sweden)

    Andrea Rosová

    2007-06-01

    Full Text Available The article describe a problem of specification and systematization of enterprise’s logistics costs. With in a growing division of labour, also logistics costs increase their part in enterprises total costs.Almost all decisions about products and production in general, influence logistics processes even logistics costs and performances.In present is not clear enough, which of the cost-particles are relevant fot logistics costs, because some of logistics cost-particles accounts within overhead are charged together with costs of other sorts.Substantive step in the process of the monitoring and evidence of logistics costs is definition of this, that costs of enterprise´s processes will be inclusive in logistics costs and determining points of contact with the others departments (acquisition, production, sale etc.. After the specification of meditation processes, there is a need to choose applicable parameters for the expression of logistics performances. Besides logistics costs is needed to know logistics performances equivalent herewith at a cost of, therefore from the control side have for enterprise bigger value indices expressive correlation costs and performances(e.g. share of logistics unit costs performance.At the proposal and evidence of logistics costs and performances is needed consistently entertain an individual conditions of enterprise. Because the area of processes included strongly affects the size of account logistics costs and its share part in total costs of enterprise. Logistics costs are flow line between economy and logistics of the enterprise.

  15. 48 CFR 231.205 - Selected costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Selected costs. 231.205... OF DEFENSE GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 231.205 Selected costs. ...

  16. A Location-Based Duplex Scheme for Cost Effective Rural Broadband Connectivity Using IEEE 802.22 Cognitive Radio Based Wireless Regional Area Networks

    Science.gov (United States)

    Kalidoss, R.; Bhagyaveni, M. A.; Vishvaksenan, K. S.

    2014-08-01

    The search for a method of utilizing the scarce spectrum in an efficient manner is an active area of research in both academic and industrial communities. IEEE 802.22 is a standard for wireless regional area network (WRAN) based on cognitive radio (CR) that operates over underutilized portions of TV bands (54-862 MHz). Time division duplex (TDD)-based WRAN cells have such advantages as dynamic traffic allocation, traffic asymmetry to users and ease of spectrum allocation. However, these cells suffer from severe cross time slot (CTS) interference when the frames of the cells are not synchronized with adjacent WRAN cells. In this paper, we evaluate the location-based duplex (LBD) scheme for eliminating the CTS interference. The proposed LBD system is much more flexible and efficient in providing asymmetric data service and eliminating CTS interference by exploiting the advantages of both TDD and frequency division duplex (FDD) schemes. We also compare the performance of LBD systems with virtual cell concepts. Furthermore, our simulation results reveal that LBD-based systems outperform the virtual cell approach in terms of the low signal-to-interference (SIR) ratio requirement by mitigating the effects of CTS.

  17. The implementation of the Common Assessment Framework in the assessment of administrative and efficiency of nursing service in General Hospital of island region.

    Directory of Open Access Journals (Sweden)

    Apostolos Efkarpidis

    2017-10-01

    Full Text Available Introduction: The Common Assessment Framework (CAF is an easy to use tool of Total Quality Management (TQM which is available to the public sector organizations in Europe. The Common Assessment Framework applied every two years providing a self-assessment framework to organizations, conceptually similar with the European Foundation Quality Management, taking into account their differences. It is common for all public organizations ensuring the comparability of results between similar services. Objective: To measure the existing administrative and operational level of Nursing Service in General Hospital. Methodology: The study was authorized by the General Manager of the Hospital. We followed the steps of the procedure provided the Implementation Guide of the CAF and used the questionnaire of the Guide. The sample consisted of 32 employees (Self-Assessment Group of all categories in a total of 101 employees. The analysis was performed with the Excel program. Results: The results of the evaluation were initiated between two rating scales based on the average (50 points a of the scale with grades from 31 to 50 (below average indicating the relative satisfaction for some activity and the moderate level of efficiency and effectiveness, and b of the scale with grades from 51 to 70 (above average indicating satisfaction for some activity and the good level of efficiency and effectiveness. The rating on the nine criteria of the CAF were: 1 Leadership (57.36, 2 Strategy – Planning (44.1, 3 Human Resource Management (50.07, 4 Partnerships – Resources (41,18, 5 Process Management – Changes (30.04, 6 Results for the Citizen (49.17, 7 Results for the Human Resources (42.13, 8 Results in Society (53, 97, 9 Main results (53,78. Conclusions: Τhe Nursing Service of the General Hospital was evaluated for its administration as well as the organizational performance by staff and citizens, based on the CAF. Seventy two weak points were spoted needing

  18. Prevalence and determinants of unintended pregnancy among pregnant woman attending ANC at Gelemso General Hospital, Oromiya Region, East Ethiopia: a facility based cross-sectional study.

    Science.gov (United States)

    Mohammed, Faiza; Musa, Abdulbasit; Amano, Abdella

    2016-08-17

    Unintended pregnancy is among the major public health problems that predispose women to maternal death and illness mainly through unsafe abortion and poor maternity care. The level of unintended pregnancy is high in developing countries. Hence, the purpose of this study is to assess the prevalence of unintended pregnancy and the associated factors among pregnant woman attending antenatal care at Gelemso General Hospital, East Ethiopia. A facility-based cross-sectional study was conducted from January 10 to April 13, 2015 among women who had attended antenatal care at Gelemso General Hospital. A systematic random sampling technique was used to select a sample of 413 participants. Data were collected via face-to-face interview using a structured and pre-tested questionnaire. Bivariate and multivariate analyses were made to check the associations among the variables and to control the confounding factors. Out of the 413 pregnancies, 112 (27.1 %) were unintended of which 90(21.9 %) were mistimed, and 22(5.2 %) were unwanted. Multivariate analysis revealed that single, divorced/widowed marital statuses, having more than 2 children, and having no awareness of contraception were significantly associated with unintended pregnancy. Over a quarter of women had an unintended pregnancy, a rate which is lower than previously reported. Designing and implementing strategies that address contraceptive needs of unmarried, divorced and widowed women, creating awareness of contraceptives at community level and reinforcing postnatal contraceptive counseling to all mothers giving birth at health institution is recommended to reduce the rate of the unintended pregnancy among parous women.

  19. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...... to facilitate resource planning and earnings forecasting. As such, this dissertation relates to the topic of firm profitability and the interpretation of cost variability. The dissertation consists of three parts that are written in the form of separate academic papers. The following section briefly summarizes...

  20. 20 CFR 225.40 - General.

    Science.gov (United States)

    2010-04-01

    ... DETERMINATIONS Cost-of-Living Increases § 225.40 General. A cost-of-living increase is an automatic increase in a... determines the percentage amount of any cost-of-living increase paid by the Board. ...

  1. Influence of region and site-specific factors on the degree of general validity of ecological and primary-energy-related assessments of biogas; Einfluss regionaler und standortspezifischer Faktoren auf die Allgemeingueltigkeit oekologischer und primaerenergetischer Bewertungen von Biogas

    Energy Technology Data Exchange (ETDEWEB)

    Dressler, Daniela

    2015-11-01

    As described in this publication, since the early 1990s numerous studies based on the life cycle assessment methodology have been dedicated to assessments of different kinds of bioenergy in comparison with fossil energy resources in terms of their energy balance and environmental impact. On reviewing the results of these studies one finds a strikingly wide range of variation. One major factor of influence on the results of life cycle assessments, besides methodological factors such as the choice of allocation method, is the representativeness of the data used. Thus, widely varying results are also obtained when balance calculations and assessments are performed on energy crops with due consideration to regional and site-specific factors. To address this problem the present study endeavoured to identify region and site-specific factors and assess them in terms of their influence on the life cycle assessment of the cultivation and conversion to biogas of different kinds of energy crops. For this purpose the following questions were explored: What influence do region, site and equipment-specific factors have on the results of ecological and primary-energy-related assessments; and how large are the differences in results between region and site-specific assessments on the one hand and assessments based on general assumptions on the other? It transpires that the results of region and site-specific assessments differ from one another in terms of both the assessment of energy cropping and the assessment of the entire process chain of biogas production and conversion to electricity.

  2. Costs of the 'Hartslag Limburg' community heart health intervention

    Directory of Open Access Journals (Sweden)

    Ruland Erik

    2006-03-01

    Full Text Available Abstract Background Little is known about the costs of community programmes to prevent cardiovascular diseases. The present study calculated the economic costs of all interventions within a Dutch community programme called Hartslag Limburg, in such a way as to facilitate generalisation to other countries. It also calculated the difference between the economic costs and the costs incurred by the coordinating institution. Methods Hartslag Limburg was a large-scale community programme that consisted of many interventions to prevent cardiovascular diseases. The target population consisted of all inhabitants of the region (n = 180.000. Special attention was paid to reach persons with a low socio-economic status. Costs were calculated using the guidelines for economic evaluation in health care. An overview of the material and staffing input involved was drawn up for every single intervention, and volume components were attached to each intervention component. These data were gathered during to the implementation of the intervention. Finally, the input was valued, using Dutch price levels for 2004. Results The economic costs of the interventions that were implemented within the five-year community programme (n = 180,000 were calculated to be about €900,000. €555,000 was spent on interventions to change people's exercise patterns, €250,000 on improving nutrition, €50,000 on smoking cessation, and €45,000 on lifestyle in general. The coordinating agency contributed about 10% to the costs of the interventions. Other institutions that were part of the programme's network and external subsidy providers contributed the other 90% of the costs. Conclusion The current study calculated the costs of a community programme in a detailed and systematic way, allowing the costs to be easily adapted to other countries and regions. The study further showed that the difference between economic costs and the costs incurred by the coordinating agency can be very

  3. Data on motivational factors of the medical and nursing staff of a Greek Public Regional General Hospital during the economic crisis.

    Science.gov (United States)

    Charalambous, Marianna; Konstantinos, Mitosis; Talias, Michael A

    2017-04-01

    In this article, we present the data related to motivational factors given by the medical (n=118) and nursing (n=217) staff, of a Greek Public General Hospital during a period of financial austerity. The data collection has been based on a structured self-administrable questionnaire which was used in a previous survey in Cyprus (Chatzicharalambous, 2015) [1]. The incentives-rewards included amount in a total to 11 (both financial and non-financial). The data contains 4 parts: (1) demographics, (2) assessment of the degree to which this hospital provided such incentives-rewards, (3) personal assessment of the participants about the significance of these incentive-rewards and (4) to what extent these incentives-rewards have increased or decreased over the last five years due to the economic crisis. The sample was analyzed as a whole on demographics and by a professional subgroup (doctors and nurses) for the other three parts. The data include quantitative tables for all parts. Finally include three tables contain multilevel models.

  4. Data on motivational factors of the medical and nursing staff of a Greek Public Regional General Hospital during the economic crisis

    Directory of Open Access Journals (Sweden)

    Marianna Charalambous

    2017-04-01

    Full Text Available In this article, we present the data related to motivational factors given by the medical (n=118 and nursing (n=217 staff, of a Greek Public General Hospital during a period of financial austerity. The data collection has been based on a structured self-administrable questionnaire which was used in a previous survey in Cyprus (Chatzicharalambous, 2015 [1]. The incentives-rewards included amount in a total to 11 (both financial and non-financial. The data contains 4 parts: (1 demographics, (2 assessment of the degree to which this hospital provided such incentives-rewards, (3 personal assessment of the participants about the significance of these incentive-rewards and (4 to what extent these incentives-rewards have increased or decreased over the last five years due to the economic crisis. The sample was analyzed as a whole on demographics and by a professional subgroup (doctors and nurses for the other three parts. The data include quantitative tables for all parts. Finally include three tables contain multilevel models.

  5. General epidemiological parameters of viral hepatitis A, B, C, and E in six regions of China: a cross-sectional study in 2007.

    Science.gov (United States)

    Lu, Jian; Zhou, Yongdong; Lin, Xiaojing; Jiang, Yongzhen; Tian, Ruiguang; Zhang, Yonghui; Wu, Jia; Zhang, Fengwei; Zhang, Yong; Wang, Yue; Bi, Shengli

    2009-12-24

    Viral hepatitis is a serious health burden worldwide. To date, few reports have addressed the prevalence of hepatitis A, B, C, and E in China. Therefore, the general epidemiological parameters of viral hepatitis remain unknown. In this cross-sectional study, we performed a serological prevalence analysis of viral hepatitis A, B, C, and E in 8,762 randomly selected Chinese subjects, which represented six areas of China. The overall prevalence of anti-Hepatitis C virus antibody (anti-HCV) was 0.58%, which was much lower than was estimated by WHO. The prevalences of Hepatitis B virus surface antigen (HBsAg), anti-Hepatitis B virus surface protein antibody (HBsAb), and anti-Hepatitis B virus core protein antibody (HBcAb) were 5.84%, 41.31%, and 35.92%, respectively, whereas in the group of subjects less than 5 years old, these prevalences were 1.16%, 46.77%, and 8.69% respectively, which suggests that the Hepatitis B virus (HBV)-carrier population is decreasing, and the nationwide HBV vaccine program has contributed to the lowered HBV prevalence in the younger generation in China. Meanwhile, a large deficit remains in coverage provided by the national HBV immune program. In addition, our data suggested the possibility that HBsAb may not last long enough to protect people from HBV infection throughout life. The overall prevalence of anti-Hepatitis A virus antibody (anti-HAV) and anti-Hepatitis E virus antibody (anti-HEV) were as high as 72.87% and 17.66%, respectively. The indices increased with age, which suggests that a large proportion of Chinese adults are protected by latent infection. Furthermore, the pattern of HEV infection was significantly different among ethnic groups in China. Our study provided much important information concerning hepatitis A, B, C, and E prevalence in China and will contribute to worldwide oversight of viral hepatitis.

  6. 24 CFR 583.135 - Administrative costs.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Administrative costs. 583.135... Administrative costs. (a) General. Up to five percent of any grant awarded under this part may be used for the purpose of paying costs of administering the assistance. (b) Administrative costs. Administrative costs...

  7. 34 CFR 300.16 - Excess costs.

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Excess costs. 300.16 Section 300.16 Education... DISABILITIES General Definitions Used in This Part § 300.16 Excess costs. Excess costs means those costs that... for an example of how excess costs must be calculated.) (Authority: 20 U.S.C. 1401(8)) ...

  8. 24 CFR 908.108 - Cost.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Cost. 908.108 Section 908.108..., RENTAL VOUCHER, AND MODERATE REHABILITATION PROGRAMS § 908.108 Cost. (a) General. The costs of the... computer hardware or software, or both, the cost of contracting for those services, or the cost of...

  9. Empathic concern drives costly altruism

    Science.gov (United States)

    FeldmanHall, Oriel; Dalgleish, Tim; Evans, Davy; Mobbs, Dean

    2015-01-01

    Why do we self-sacrifice to help others in distress? Two competing theories have emerged, one suggesting that prosocial behavior is primarily motivated by feelings of empathic other-oriented concern, the other that we help mainly because we are egoistically focused on reducing our own discomfort. Here we explore the relationship between costly altruism and these two sub-processes of empathy, specifically drawing on the caregiving model to test the theory that trait empathic concern (e.g. general tendency to have sympathy for another) and trait personal distress (e.g. predisposition to experiencing aversive arousal states) may differentially drive altruistic behavior. We find that trait empathic concern – and not trait personal distress – motivates costly altruism, and this relationship is supported by activity in the ventral tegmental area, caudate and subgenual anterior cingulate, key regions for promoting social attachment and caregiving. Together, this data helps identify the behavioral and neural mechanisms motivating costly altruism, while demonstrating that individual differences in empathic concern-related brain responses can predict real prosocial choice. PMID:25462694

  10. Comparison of The Means of Argyrophilic Nucleolar Organizer Region (mAgNOR Pre- and Post-Therapy in Nasopharyngeal Carcinoma Patients at Wahidin Sudirohusodo General Hospital Makassar

    Directory of Open Access Journals (Sweden)

    Freddy George Kuhuwael

    2016-08-01

    Full Text Available BACKGROUND: Nasopharyngeal carcinoma (NPC is malignant tumor growing in nasopharynx with a predilection in fossa Rossenmuller and nasopharyngeal roof. This research aimed to prove whether the means of argyrophilic nucleolar organizer region (mAgNOR can predict the success of treatment in nasopharyngeal carcinoma patients. METHODS: We used diagnostic test method with longitudinal design and purposive sampling technique. Endoscopic biopsy examination was performed on 15 nasopharyngeal carcinoma patients before and after therapy, 13 patients underwent chemotherapy and other two underwent chemoradiotherapy. Tumor tissues were stained and AgNOR was calculated. RESULTS: Based on the tumor stage, sample characteristic showed 3 patients (20% were in stage II, 3 patients (20% in stage III, and 9 patients (60% in stage IV, with pre- and post-therapy mAgNOR were 1.610±0.988 and 1.000±0.000, respectively in stage II, 1.100±0.092 and 1.000±0.000, respectively in stage III, 1.226±0.265 and 1.107±0.164, respectively in stage IV patients. Based on histopathology type, 4 patients (26.7% had non keratinizing squamous cell carcinoma with pre- and post-therapy mAgNOR were 1.117±0.134 and 1.060±0.120, respectively, while 11 patients (73.3% had undifferentiated squamous cell carcinoma with pre- and post-therapy mAgNOR were 1.335±0.528 and 1.065±0.146, respectively. Overall the pre-therapy were significantly higher than post-therapy mAgNOR. In subgroups there are significant differences in stage IV and type 3. CONCLUSION: The values of AgNOR were decreased in all NPC stages and significantly decreased in undifferentiated squamous cell carcinoma. AgNOR can be used to predict the successfulness of therapy in NPC. KEYWORDS: nasopharyngeal carcinoma, therapy, proliferation, mAgNOR

  11. Alcohol use disorder and associated factors among human immunodeficiency virus infected patients attending antiretroviral therapy clinic at Bishoftu General Hospital, Oromiya region, Ethiopia.

    Science.gov (United States)

    Bultum, Jemal Abdella; Yigzaw, Niguse; Demeke, Wubit; Alemayehu, Mekuriaw

    2018-01-01

    Alcohol consumption among patients with HIV/AIDS increases the burden of the disease. HIV/AIDS is an epidemic among Sub-Saharan African countries. Excessive use of alcohol causes a large degree of health problems, social and economic burden in societies. However, the prevalence and associated factors of alcohol use disorder among this group of people has not been studied very well. Therefore, this study sought to assess the magnitude and associated factors of alcohol use disorder among HIV patients attending the antiretroviral (ART) clinic. A hospital based cross sectional study design was conducted at Bishoftu General Hospital from May to June 2015. Systematic random sampling technique was used to select the study participants. Data was collected by face to face interview and chart review. Alcohol Use Disorder Identification Test (AUDIT) was used to assess alcohol use disorder. Bivariate and multivariate logistic regression analysis was carried out to identify associated factors and P-value < 0.05 was taken as statistically significant. A total of 527 participants were enrolled in the study with a response rate of 100%. The prevalence of alcohol use disorder (AUD) was 14.2%. Factors associated with alcohol use disorder were educational status AOR = 8.5 (95%CI: 1.70, 42.99), social support AOR = 0.5(95%CI: 0.26, 0.95), cigarette smoking AOR = 3.49(95%CI: 1.01, 12.13), khat chewing AOR = 5.11 (95% CI: 1.60, 16.33), family history of alcohol use AOR = 3.58 (95% CI: 1.52, 8.47), and missing ART drugs AOR 3.05 (95% CI: 1.302, 7.131). The prevalence of alcohol use disorder was high as compared to similar epidemiological studies. Educational status, social support, cigarette smoking, khat chewing, and family history of alcohol use were independent predictors. Providing health education about alcohol use and proper screening of alcohol use disorder among patients with HIV/AIDS is crucial. Strengthening the referral linkage with the psychiatric unit will decrease the

  12. Investigations of excretion rates of the radionuclides {sup 230}Th, {sup 226}Ra, {sup 210}Pb and {sup 210}Po of persons of the general population and of workers in selected regions in Germany

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, I. [Nuclear Engineering and Analytics Rossendorf Inc. D-01328 Dresden (Germany); Seitz, G. [Institution for statutory accident insurance and prevention in the precision engineering and electrical industry, D-50941 Koeln (Germany); Hartmann, M. [Federal Office for Radiation Protection, D-10318 Berlin (Germany)

    2006-07-01

    According to ICRP 60 and European-Directive 96/29, Naturally Occurring Radioactive Materials (NORM) and Technical Enriched Naturally Occurring Radioactive Materials (TENORM) have to take the radiation protection of the general population as well as of workers into account. The German radiation protection regulations stress that particularly. In connection with these regulations, various measurement programs have been and still are performed to investigate the relevant exposure paths. One of these programs is the determination of the intake of natural occurring radionuclides of the uranium decay series in individuals of the public, in exposed regions and houses and also at NORM workplaces by excretion analysis. Excretion analysis surveillance is one of the common tools for internal dosimetry. Sources of primordial radionuclides could be the ingestion of foodstuff and water and the incorporation of (mostly airborne) pollution on work places. The main focus in this report is set upon the excretion rate in faeces and urine. A cohort of about 100 persons was selected in five regions in Germany. One of these regions we chose to be the reference area. It is situated in the northern part of Germany with low background radiation. The other regions are in the south-west and south-east mountain areas. Workers were selected from drinking water providers, natural gas providers, balneologic facilities and exhibition mines and museum pits. In the same region also persons of public were recruited for the study. The paper presents selected data of the above mentioned nuclides in urine and faeces samples which were collected during 2002 to 2005. The results are grouped due the parameters like regions and working fields and are discussed in detail. These are 15 mBq/d in urine and 70 mBq/d in faeces and are not as different for the different nuclides as one may expect. (authors)

  13. Investigations of excretion rates of the radionuclides 230Th, 226Ra, 210Pb and 210Po of persons of the general population and of workers in selected regions in Germany

    International Nuclear Information System (INIS)

    Schaefer, I.; Seitz, G.; Hartmann, M.

    2006-01-01

    According to ICRP 60 and European-Directive 96/29, Naturally Occurring Radioactive Materials (NORM) and Technical Enriched Naturally Occurring Radioactive Materials (TENORM) have to take the radiation protection of the general population as well as of workers into account. The German radiation protection regulations stress that particularly. In connection with these regulations, various measurement programs have been and still are performed to investigate the relevant exposure paths. One of these programs is the determination of the intake of natural occurring radionuclides of the uranium decay series in individuals of the public, in exposed regions and houses and also at NORM workplaces by excretion analysis. Excretion analysis surveillance is one of the common tools for internal dosimetry. Sources of primordial radionuclides could be the ingestion of foodstuff and water and the incorporation of (mostly airborne) pollution on work places. The main focus in this report is set upon the excretion rate in faeces and urine. A cohort of about 100 persons was selected in five regions in Germany. One of these regions we chose to be the reference area. It is situated in the northern part of Germany with low background radiation. The other regions are in the south-west and south-east mountain areas. Workers were selected from drinking water providers, natural gas providers, balneologic facilities and exhibition mines and museum pits. In the same region also persons of public were recruited for the study. The paper presents selected data of the above mentioned nuclides in urine and faeces samples which were collected during 2002 to 2005. The results are grouped due the parameters like regions and working fields and are discussed in detail. These are 15 mBq/d in urine and 70 mBq/d in faeces and are not as different for the different nuclides as one may expect. (authors)

  14. Simple, Low-Cost Detection of Candida parapsilosis Complex Isolates and Molecular Fingerprinting of Candida orthopsilosis Strains in Kuwait by ITS Region Sequencing and Amplified Fragment Length Polymorphism Analysis.

    Science.gov (United States)

    Asadzadeh, Mohammad; Ahmad, Suhail; Hagen, Ferry; Meis, Jacques F; Al-Sweih, Noura; Khan, Ziauddin

    2015-01-01

    Candida parapsilosis has now emerged as the second or third most important cause of healthcare-associated Candida infections. Molecular studies have shown that phenotypically identified C. parapsilosis isolates represent a complex of three species, namely, C. parapsilosis, C. orthopsilosis and C. metapsilosis. Lodderomyces elongisporus is another species phenotypically closely related to the C. parapsilosis-complex. The aim of this study was to develop a simple, low cost multiplex (m) PCR assay for species-specific identification of C. parapsilosis complex isolates and to study genetic relatedness of C. orthopsilosis isolates in Kuwait. Species-specific amplicons from C. parapsilosis (171 bp), C. orthopsilosis (109 bp), C. metapsilosis (217 bp) and L. elongisporus (258 bp) were obtained in mPCR. Clinical isolates identified as C. parapsilosis (n = 380) by Vitek2 in Kuwait and an international collection of 27 C. parapsilosis complex and L. elongisporus isolates previously characterized by rDNA sequencing were analyzed to evaluate mPCR. Species-specific PCR and DNA sequencing of internal transcribed spacer (ITS) region of rDNA were performed to validate the results of mPCR. Fingerprinting of 19 clinical C. orthopsilosis isolates (including 4 isolates from a previous study) was performed by amplified fragment length polymorphism (AFLP) analysis. Phenotypically identified C. parapsilosis isolates (n = 380) were identified as C. parapsilosis sensu stricto (n = 361), C. orthopsilosis (n = 15), C. metapsilosis (n = 1) and L. elongisporus (n = 3) by mPCR. The mPCR also accurately detected all epidemiologically unrelated C. parapsilosis complex and L. elongisporus isolates. The 19 C. orthopsilosis isolates obtained from 16 patients were divided into 3 haplotypes based on ITS region sequence data. Seven distinct genotypes were identified among the 19 C. orthopsilosis isolates by AFLP including a dominant genotype (AFLP1) comprising 11 isolates recovered from 10 patients. A

  15. PENETAPAN TARGET TERHADAP STICKINESS COST

    Directory of Open Access Journals (Sweden)

    Windyastuti Windyastuti

    2017-03-01

    Full Text Available This study aimed to analyze the influence of manager targeting to the stickiness cost. The research data was amanufacturing company’s financial statements during 1999-2011 published at BEI. The research data includedcost of sales, administration and general, net sales and Price Earnings Ratio (PER. This study used adynamic panel data regression analysis. The results showed that cost of sales, administration and general weresticky. Furthermore, manager targeting caused the stickiness degree of sales, administration and general costlower. Manager targeting changed the manager’s behavior. When the net sales declined, manager reduced theresource use drastically so the cost of sales, administration and general also decreased drastically.

  16. 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...

  17. The cost of children

    DEFF Research Database (Denmark)

    Nordström, Leif Jonas

    , the opportunity cost of two children is estimated to 28-29 per cent of full income, which in monetary units is close to estimated income difference between women employed in the public and private sector. The opportunity cost of fatherhood is generally positive, but only significantly positive for men born......In this paper we estimate the opportunity cost of children. The underlying theoretical model is represented by a household production model. In the empirical analysis, we consider three different cohorts for men and women born between 1955 and 1970. For the women in the two oldest cohorts...

  18. A minisum model with forbidden regions for locating a semi-desirable facility in the plane

    DEFF Research Database (Denmark)

    Juel, Henrik; Brimberg, Jack

    1998-01-01

    -desirable facility that accounts for the service costs by a standard minisum objective with arbitrary travel distance function. The social costs are imputed by specifying around each demand point or population center a convex forbidden region, also defined by an arbitrary distance metric, in which the new facility...... may not be located. A general solution algorithm is suggested, and the methodology is applied to circular forbidden regions and special travel distance functions....

  19. A minisum model with forbidden regions for locating a semi-desirable facility in the plane

    DEFF Research Database (Denmark)

    Brimberg, Jack; Juel, Henrik

    -desirable facility which accounts for the service costs by a standard minisum objective with arbitrary travel distance function. The social costs are imputed by specifying around each demand point or population center a convex forbidden region, also defined by an arbitrary distance metric, in which the new facility...... may not be located. A general solution algorithm is suggested, and the methodology applied to circular forbidden regions and special travel distance functions....

  20. Nuclear power costs

    International Nuclear Information System (INIS)

    1963-01-01

    A report prepared by the IAEA Secretariat and presented to the seventh session of the Agency's General Conference says that information on nuclear power costs is now rapidly moving from the domain of uncertain estimates to that of tested factual data. As more and more nuclear power stations are being built and put into operation, more information on the actual costs incurred is becoming available. This is the fourth report on nuclear power costs to be submitted to the IAEA General Conference. The report last year gave cost information on 38 nuclear power projects, 17 of which have already gone into operation. Certain significant changes in the data given last year are included-in the present report; besides, information is given on seven new plants. The report is divided into two parts, the first on recent developments and current trends in nuclear power costs and the second on the use of the cost data for economic comparisons. Both stress the fact that the margin of uncertainty in the basic data has lately been drastically reduced. At the same time, it is pointed out, some degree of uncertainty is inherent in the assumptions made in arriving at over-all generating cost figures, especially when - as is usually the case - a nuclear plant is part of an integrated power system